PMC6159149_01
85-year-old male patient who presented with acute right-sided weakness. (a) Sagittal, (b) axial and (c) coronal CTA images demonstrate a carotid web arising from the posterior wall of the proximal left ICA. CTA, CT angiogram; ICA, internal carotid artery.
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CT head revealed established bilateral corona radiata infarcts. CT angiogram (CTA) demonstrated a left internal carotid artery (ICA) web (Figure 1).
85-year-old male patient who presented with acute right-sided weakness. Carotid duplex ultrasonography left ICA: irregular echogenic plaque at the origin of the left ICA resulting in 0-29% stenosis. ICA, internal carotid artery.
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On carotid duplex ultrasonography, an irregular mixed echogenic plaque (query ulcerated) was seen at the origin of the left ICA causing a 0-29% stenosis (Figure 2).
85-year-old male patient who presented with acute right-sided weakness. Contrast enhanced MRA of the left carotid demonstrates a web arising from the proximal left ICA at the level of the carotid bifurcation. ICA, internal carotid artery; MRA, magnetic resonance angiogram.
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Magnetic resonance angiogram (MRA) carotid arteries also demonstrated a shelf-like projection arising from the posterior wall of the left ICA consistent with a carotid web (Figure 3).
PMC6159149_02
Bilateral carotid webs. CTA images of a 39-year-old male patient who presented with an acute left M1 occlusion with a background history of a prior left MCA infarct. (a and b) Axial and sagittal CTA images demonstrate a carotid web arising from the posterior wall of the proximal left ICA. (c and d) Axial and sagittal CTA images demonstrate a carotid web arising from the posterior wall of the proximal right ICA. CTA, CT angiogram; ICA, internal carotid artery; MCA, middle cerebral artery.
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His CT angiogram intracranial confirmed an acute occlusion of the M1 portion of the left middle cerebral artery and revealed two separate foci of soft plaques arising from the posterior wall of the origin of the left and right ICA with accompanying carotid webs on both sides (Figure 4).
39-year-old male patient who presented with an acute left M1 occlusion with a background history of a prior left MCA infarct. Contrast enhanced MRA MIP image of the neck arteries demonstrate webs arising from the posterior walls of the proximal right (long arrow) and left (short arrow) internal carotid arteries. MCA, middle cerebral artery; MRA, magnetic resonance angiogram.
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His MRA carotids showed a haemorrhagic "plaque" at the origin of the left ICA but no high-grade ICA stenosis or any evidence of dissection (Figure 5).
39-year-old male patient who presented with an acute left M1 occlusion with a background history of a prior left MCA infarct. Axial fat-saturated T1W MRI: crescentic hyper intense signal at the posterior aspect of the origin of the left ICA consistent with haemorrhage within the known carotid web. ICA, internal carotid artery; MCA, middle cerebral artery; T1W, T
1 weighted.
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Axial fat-saturated T1W MRI demonstrated a crescentic hyperintense signal at the posterior aspect of the origin of the left ICA consistent with haemorrhage within the known carotid web (Figure 6).