Informations générales (source: ClinicalTrials.gov)
Characteristics in Doppler Ultrasound of the Carotid Diaphragm Responsible for an Ischemic Stroke (DIADOP)
Observational
Fondation Hôpital Saint-Joseph (Voir sur ClinicalTrials)
juin 2020
décembre 2023
29 juin 2024
Carotid diaphragms are a non-atheromatous arterial cause of cerebral infarction,
especially in young people (≤65 years old). This anomaly is more common in the African or
African-American population, although it is more and more often discovered in young
Caucasians. This cause of cerebrovascular accident (CVA), known until the 1970s, was
later forgotten until a recent revival of interest, probably in connection with the
improvement of imagery but also by the discovery that these lesions have a high rate of
recurrence in the absence of interventional care. In a Brazilian study, the carotid
diaphragm was reported in 10% of patients under the age of 60.
The carotid diaphragm is a non-atheromatous overgrowth of the intima of the arterial
wall. It appears in imagery in the form of an endoluminal web wider than it is tall. Its
preferred seat is the carotid bulb. It is a source, by an embologenic mechanism, of
cerebral infarction starting from local thrombus developed within large cerebral
arteries. In histology, the lesions are different from atherosclerosis and characterized
by a thickening of the intima with proliferation of loose and strewed spindle cells
mainly involving the intima.
An atheromatous plaque or dissection with detachment of the intima are the two main
differential diagnoses of the carotid web. However, the appearance of a diaphragm
implanted on a regular wall and the absence of any other localization of atheroma
distinguish the lesion of the carotid web from that of a focal atheromatous plate. In
addition, the very proximal localization of the carotid web, from the emergence of the
internal carotid artery, does not suggest a dissection, the localization of which is
usually downstream of the bulb.
The baseline exam to detect a carotid diaphragm is a carotid angiography scan, but the
abnormalities are often inconspicuous, making diagnosis difficult. We can be led in case
of doubt to perform a conventional arteriography, which remains the "gold standard". The
latter, dynamic examination compared to the CT scan, shows above all a stasis of blood
flow in the recess created by the diaphragm, stasis at the origin of the formation of
thrombi. It has been suspected that the maximum risk of infarction is upon waking, at the
time of verticalization, with mobilization of the thrombus.
Therapeutically, the discovery of a symptomatic carotid diaphragm (ischemic swallowing
accident) justifies radical treatment. The risk of recurrence of a patient on
antithrombotic (antiplatelet or anticoagulant) being too high, it is proposed either
surgery, or carotid angioplasty with stent placement. No comparative study of the 2
techniques has been carried out.
Besides radiological examinations, ultrasound is another technique for studying the
cervical arteries. It is reputed to be of little contribution in the search for a carotid
diaphragm, but few publications exist to date even though the cervical Doppler is often
the first arterial examination carried out after an ischemic stroke. Two series reported
Doppler ultrasound data in the carotid diaphragm. A recent retrospective study evaluated,
in multimodal imaging [Doppler, CT scan of the Supra-Aortic Trunks (ASD) and conventional
arteriography], 30 patients (60 carotids) with diaphragm or atherosclerosis. The
correlation between conventional arteriography and CT angiography was perfect, but the
correlation between Doppler and CT angiography for diaphragm diagnosis was moderate. In
another series studying 15 diaphragms diagnosed by CT angiography, the retrospective
analysis of doppler reports revealed that 40% were considered normal and 60% mentioned
nonspecific hyperechoic lesions, but this work remained in the form of a presentation. at
a congress. With the improvement of the technique and the resolution of the Doppler
ultrasound as well as the knowledge of the particular ultrasound characteristics, it
seems to us that this examination could regain a place in the diagnosis of the pathology.
The carotid diaphragm is also largely unknown to vascular doctors practicing cervical
Doppler ultrasound.
This descriptive study of the diagnostic contribution of the echo-doppler for a carotid
diaphragm has for perspective the establishment of a prospective study of the
contribution of a combined expertise angiologist-neurologist in the echo-Doppler for
patients <60 years hospitalized for an ischemic stroke.
Etablissements
| Les établissements d'Île-de-France dont les données sont issues de ClinicalTrials.gov Origine et niveau de fiabilité des données | |||||
|---|---|---|---|---|---|
| GH PARIS SITE SAINT JOSEPH | Ruben TAMAZYAN, MD | Contact (sur clinicalTrials) | |||
Critères
Tous
Inclusion Criteria:
- Patient whose age is> 18 years old and ≤65 years old
- Patients treated in the neurology department for an infarction or transient ischemic
attack for which the diagnosis of ipsilateral carotid diaphragm was accepted,
between April 2017 and April 2020
- French speaking patients
- Patient whose age is> 18 years old and ≤65 years old
- Patients treated in the neurology department for an infarction or transient ischemic
attack for which the diagnosis of ipsilateral carotid diaphragm was accepted,
between April 2017 and April 2020
- French speaking patients
- Patient under guardianship or curatorship
- Patient deprived of liberty
- Patient objecting to the use of his data for this research