Carotid Web as a Treatable Etiology of Recurrent Cryptogenic Ischemic Stroke Highlighting Neurointervention: A Case Report and Literature Review
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Abstract Introduction Carotid web is a rare focal variant of intimal fibromuscular dysplasia characterized by a thin, shelf-like projection from the posterior wall of the carotid bulb into the arterial lumen. This abnormality can disturb blood flow and promote thrombus formation, increasing the risk of transient ischemic attacks (TIAs) and ischemic strokes. Case Presentation A 55-year-old male, known case of hypertension, presented with sudden-onset dysarthria and left-sided weakness. Initial imaging revealed no acute infarction, and an underlying cause remained unclear. Despite receiving dual antiplatelet therapy and statin, he experienced a recurrent TIA within a week. Digital subtraction angiography revealed a focal shelf-like intraluminal projection in the right internal carotid artery, consistent with a carotid web. Carotid artery stenting (CAS) was performed successfully without any immediate complications. The patient was then commenced on clopidogrel for 3 months and lifelong aspirin. At the 1-month and 3-month follow-ups, he remained symptom-free and had no recurrence. Conclusion This case highlights carotid web as a potential but underrecognized cause of recurrent ischemic events, illustrating both the diagnostic challenge of distinguishing it from atherosclerotic plaque with shelf-like configuration and the value of revascularization therapy. Early recognition and timely management by either CAS or carotid endarterectomy can prevent recurrent neurological deficits.
Abstract
Abstract Introduction Carotid web is a rare focal variant of intimal fibromuscular dysplasia characterized by a thin, shelf-like projection from the posterior wall of the carotid bulb into the arterial lumen. This abnormality can disturb blood flow and promote thrombus formation, increasing the risk of transient ischemic attacks (TIAs) and ischemic strokes. Case Presentation A 55-year-old male, known case of hypertension, presented with sudden-onset dysarthria and left-sided weakness. Initial imaging revealed no acute infarction, and an underlying cause remained unclear. Despite receiving dual antiplatelet therapy and statin, he experienced a recurrent TIA within a week. Digital subtraction angiography revealed a focal shelf-like intraluminal projection in the right internal carotid artery, consistent with a carotid web. Carotid artery stenting (CAS) was performed successfully without any immediate complications. The patient was then commenced on clopidogrel for 3 months and lifelong aspirin. At the 1-month and 3-month follow-ups, he remained symptom-free and had no recurrence. Conclusion This case highlights carotid web as a potential but underrecognized cause of recurrent ischemic events, illustrating both the diagnostic challenge of distinguishing it from atherosclerotic plaque with shelf-like configuration and the value of revascularization therapy. Early recognition and timely management by either CAS or carotid endarterectomy can prevent recurrent neurological deficits. Additional studies and case reports are needed to improve understanding of carotid web and to guide the development of evidence-based management strategies.