Introduction. Carotid diaphragm (CD) is considered a focal form of fibromuscular dysplasia, and a rare causes of ischemic stroke. We have collected three cases of CD over a 2-year period, suggesting that its frequency may be higher than previously thought. Patients and Methods. We have prospectively collected all cases of CD among patients with ischemic stroke or TIA admitted to our Stroke Unit during the last two years. A CD was diagnosed when CT- or MR-angiography showed an image of a spur arising from the posterior wall of the carotid and a thin septum in axial images at this level, without signs of atherosclerosis of the ipsilateral bifurcation. Results. Out of 671 patients, 3 cases showed a CD (0.45%). They were 3 women aged 34, 59, and 64 years. One patient had had a previous ipsilateral territorial stroke 7 years before the index event. The 64-year-old case had a symptomatic contralateral atherosclerotic carotid occlusion, while the CD was asymptomatic. The CD was bilateral in 1 case. Only one case had positive findings at Duplex ultrasound. Two patients underwent stenting of the symptomatic diaphragm. Conclusions. Although infrequent, a carotid diaphragm seems to be not so exceptional among patients with ischemic stroke or TIA. Since slightly less than 50% of our patients had a CT- or MR-angiography, the frequency of CD may well be higher than the one we found, especially among women. Differentiation from mural thrombus or atherosclerotic lesions may not be straightforward in all cases.
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