Diaphragms of the carotid and vertebral arteries: an under-diagnosed cause of ischaemic stroke

Background and purpose Diaphragms of the internal carotid and vertebral arteries as a cause of ischaemic stroke are reported and stenting of diaphragms as a therapeutic option in stroke secondary prevention is described. Methods Five patients were cared for in our institution from 2000 to 2011 for r...

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Bibliographic Details
Published in:European journal of neurology 2014-04, Vol.21 (4), p.586-593
Main Authors: Lenck, S., Labeyrie, M.-A., Saint-Maurice, J.-P., Tarlov, N., Houdart, E.
Format: Article
Language:English
Subjects:
Adult
Aged
Carotid Arteries - pathology
cerebrovascular disease/stroke
Diaphragm - pathology
Female
Follow-Up Studies
Humans
imaging
Ischemia - complications
Magnetic Resonance Imaging
Male
Medical imaging
Middle Aged
Retrospective Studies
Sensitivity and Specificity
Stroke
Stroke - diagnosis
Stroke - etiology
stroke in young adults
Ultrasonography, Doppler
Vertebral Artery - pathology
Young Adult
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Summary:Background and purpose Diaphragms of the internal carotid and vertebral arteries as a cause of ischaemic stroke are reported and stenting of diaphragms as a therapeutic option in stroke secondary prevention is described. Methods Five patients were cared for in our institution from 2000 to 2011 for recurrent ischaemic strokes which were classified to be of undetermined aetiology after completion of the usual investigations. Because the patients had already had ischaemic strokes in the territory of the same artery, a conventional digital subtracted angiography was performed. A diaphragm was identified on the artery that supplied the territory in which the stroke occurred. The stroke was therefore attributed to the diaphragm. Clinical and radiological data, treatment and the clinical course of the patients was retrospectively reviewed. Results The diaphragm was located in the vertebral artery in three cases and in the bulb of the internal carotid artery in two. In all cases cerebral MR showed ischaemic strokes of different ages downstream of the diaphragm. Stenting was performed in four cases. No patient had a symptomatic recurrent ischaemic event after stenting. Conclusions Diaphragms are a rare cause of recurrent embolic strokes which are often not detected with non‐invasive imaging. Stenting appears to be a therapeutic option in stroke secondary prevention. These observations suggest that conventional angiography should be performed in cases of recurrent ischaemic strokes in the territory of a single artery and in cases of ischaemic stroke of undetermined aetiology in young adults when the usual investigations are negative.
ISSN:1351-5101
1468-1331
DOI:10.1111/ene.12343