Clinical Report: A Case Study of Myofibroblast Accumulation in a Carotid Web

Overview

This case study presents a 49-year-old male with an asymptomatic carotid web, highlighting the potential role of myofibroblast dysregulation in its pathogenesis. The findings suggest a high risk of stroke despite mild stenosis, emphasizing the need for careful management.

Background

Carotid webs are associated with increased risk of ischemic stroke, particularly in younger patients. They are often underdiagnosed and can lead to significant morbidity due to embolic events. Understanding the pathophysiology and optimal management strategies for carotid webs is crucial for preventing recurrent strokes.

Data Highlights

No numerical data available in the article.

Key Findings

• Carotid webs are associated with turbulence and stasis of blood flow, increasing stroke risk.
• Prevalence of carotid webs in patients under 60 with cryptogenic stroke is 9–37%.
• Recurrence rate of stroke in symptomatic carotid web cases can reach 20% within 2 years.
• Carotid endarterectomy (CEA) may be a viable treatment option despite current guidelines favoring observation for asymptomatic cases.
• Histopathological analysis suggests myofibroblast dysregulation may initiate carotid web formation.

Clinical Implications

Clinicians should consider carotid webs as a potential cause of ischemic stroke in younger patients, especially those with cryptogenic strokes. The findings support the need for careful imaging and consideration of surgical intervention in symptomatic cases.

Conclusion

This case underscores the importance of recognizing carotid webs as a significant risk factor for stroke and the potential role of myofibroblasts in their pathogenesis. Further research is needed to clarify optimal management strategies.

References

1. European Society for Vascular Surgery (ESVS), 2023 -- Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease
2. Stroke Manual -- Carotid artery web
3. Clinical Research in Cardiology — Nerve Distribution and Density in Proximity to the Carotid Artery Bifurcation
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5. Basic Research in Cardiology — Fibrofatty Changes in Arrhythmogenic Cardiomyopathy
6. Basic Research in Cardiology — Single-cell transcriptomic analysis identifies unique fibroblast activation patterns in heart failure with preserved ejection fraction
7. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease
8. Carotid artery web | STROKE MANUAL