Carotid Stenting for Treatment of Symptomatic Carotid Webs: A Single-Center Case Series

Abstract

Background and Purpose: Carotid webs are an increasingly recognized cause of acute is­chemic stroke, particularly in younger adults. The optimal medical and surgical strategies for managing these lesions have not been well established. We report a single-center case series of carotid stenting for treatment of symptomatic carotid webs. Materials and Methods: Consecutive patients undergoing stent placement for treatment of symptomatic carotid webs were included. Carotid webs were defined as a thin intraluminal filling defect along the posterior wall of the carotid bulb just beyond the carotid bifurcation on CTA. Data were collected on demographic characteristics, antiplatelet management, clinical presentation, imaging findings, treatment characteristics, complications, and stroke recurrence rates. Descriptive statistics are reported. Results: A total of 4 patients were treated. Their mean age was 44 years (range 30–50). Three patients were female and 1 was male. All patients were symptomatic presenting with ipsilateral transient ischemic attacks or stroke. Patients were placed on dual antiplatelet therapy with ticagrelor and aspirin prior to the procedure. There were no ischemic or hemorrhagic complications. Three patients had postoperative bradycardia, 1 of whom required atropine immediately following stenting. No patients had recurrent ischemic events. Conclusions: Stent placement for treatment of carotid webs can be performed safely. Further studies are needed to confirm our findings.

Stroke Recurrence in First-Ever Symptomatic Carotid Web: A Cohort Study

“…Surgery has been proposed as invasive treatment option, 3 and small series of carotid endarterectomy in symptomatic CaW have reported data for acceptable safety and efficacy after a median follow-up around 12 months. 3,13,[24][25][26] Endovascular procedure has also been reported as safe, 27 and a recent study 28 showed that the procedure performed in 24 symptomatic CaW patients was effective to prevent recurrence after a median clinical follow-up of 12 months. Although no randomized data are available, invasive treatment such as surgery or stenting seems now increasingly proposed as secondary preventive strategy.…”

Safety and feasibility of carotid revascularization in patients with cerebral embolic strokes associated with carotid webs and histopathology revisited

“…Surgical endarterectomy for a carotid web has a success rate similar to stenting, but with greater cost, longer recovery time, and more risk of neck hematoma or anesthetic complication than endovascular procedures. 6,25–27 Joux et al. in a 5 year study on Afro-Caribbean patients identified 25 patients with embolic stroke associated with a carotid web.…”

Image and clinical analysis of common carotid web: a case report

“…Carotid artery stenting is a safe and effective method for treating a carotid web, with low perioperative complications and good short-term results. The time of carotid artery stent placement is shorter than that of carotid endarterectomy [ 15 ]. The present study had a small sample size.…”