Endarterectomy for symptomatic internal carotid artery web

Abstract

OBJECTIVEThe carotid web (CW) is an underrecognized source of cryptogenic, embolic stroke in patients younger than 55 years of age, with up to 37% of these patients found to have CW on angiography. Currently, there are little data detailing the best treatment practices to reduce the risk of recurrent stroke in these patients. The authors describe their institutional surgical experience with patients treated via carotid endarterectomy (CEA) for a symptomatic internal carotid artery web.METHODSA retrospective, observational cohort study was performed including all patients presenting to the authors’ institution with CW. All patients who were screened underwent either carotid artery stenting (CAS) or CEA after presentation with ischemic stroke from January 2019 to February 2020. From this sample, patients with suggestive radiological features and pathologically confirmed CW who underwent CEA were identified. Patient demographics, medical histories, radiological images, surgical results, and clinical outcomes were collected and described using descriptive statistics.RESULTSA total of 45 patients with symptomatic carotid lesions were treated at the authors’ institution during the time period. Twenty patients underwent CAS, 1 of them for a CW. Twenty-five patients were treated via CEA, and of these, 6 presented with ischemic strokes ipsilateral to CWs, including 3 patients who presented with recurrent strokes. The mean patient age was 55 ± 12.6 years and 5 of 6 were women. CT angiography or digital subtraction angiography demonstrated the presence of CWs ipsilateral to the stroke in all patients. All patients underwent resection of CWs using CEA. There were no permanent procedural complications and no patients had stroke recurrence following intervention at the latest follow-up (mean 6.1 ± 4 months). One patient developed mild tongue deviation most likely related to retraction, with complete recovery at follow-up.CONCLUSIONSCEA is a safe and feasible treatment for symptomatic carotid webs and should be considered a viable alternative to CAS in this patient population.

Multimodality imaging of carotid web: A case report and literature review

“…In most publications, CW was defined as a shelf-like septum in the posterior wall of the carotid bulb. 1, 2, 4, 5, 7, 9-11, 13, 16–19, 23-28 On the other hand, the greater development and thickness of the intima and the greater amount of elastic fibers in carotid vessel are probably linked to the presence of a higher frequency of CW on the carotid artery. 29 The mean length of symptomatic CW was relatively longer than asymptomatic CW.…”

“…3,4,16,18 The prevalence of symptomatic CW in patients who were operated on for a carotid stenosis varies from 3.0 to 15.6%. 7,19 After our literature review, the prevalence of symptomatic CW was 1.2% in patients with transient ischemic attack/stroke, 6.4% in patients with cryptogenic ischemic stroke, 1.1% in patients with large vessel occlusion stroke, and 4.4% in patients who operated on for carotid stenosis. Similar to the systematic review published by Zhang et al in 2018, 20 our study found that patients with CW were relatively young, with a higher prevalence of women.…”

Histopathological Examination of a Symptomatic Carotid Web: A Case Report

“…In several studies, pathological examinations revealed that a CaW is a subtype of fibromuscular dysplasia. 1 , 2 , 14 , 15 ) A typical characteristic of CaW is intimal fibrous hyperplasia with minimal medial degeneration, 2 , 16 ) sometimes containing fibroelastic tissue with muscular tissue 17 ) and fibroelastic tissue with areas of myxoid degeneration. 18 ) In our case, the CaW showed different developmental phases with new intimal hyperplasia overlying the CaW distally.…”

The Value of Contrast-Enhanced Ultrasound in the Evaluation of Carotid Web

“…CAS is the preferred treatment strategy because of its safety and effectiveness ( 43 ). Moreover, it has fewer perioperative complications ( 44 ). In this study, medical management, CAS, and CEA were used.…”