Endarterectomy for symptomatic internal carotid artery web

Area of Science:

• Neurology
• Vascular Surgery
• Radiology

Background:

• Carotid web (CW) is an underrecognized cause of cryptogenic stroke, particularly in patients under 55.
• Limited data exist on optimal treatment strategies for symptomatic CW to prevent recurrent strokes.
• Internal carotid artery webs are increasingly identified as a source of embolic stroke.

Purpose of the Study:

• To evaluate the safety and efficacy of carotid endarterectomy (CEA) for treating symptomatic internal carotid artery webs.
• To describe the institutional surgical experience with CEA for CW.
• To assess the risk of recurrent stroke after CEA in patients with CW.

Main Methods:

• Retrospective observational cohort study of patients with CW treated between January 2019 and February 2020.
• Inclusion of patients with radiological and pathological confirmation of CW who underwent CEA.
• Collection and descriptive statistical analysis of patient demographics, medical history, imaging, surgical outcomes, and clinical follow-up.

Main Results:

• Twenty-five patients underwent CEA for symptomatic carotid lesions; 6 had strokes ipsilateral to CWs, including 3 with recurrent strokes.
• All 6 patients with CWs underwent successful resection via CEA with no permanent procedural complications.
• No patients experienced stroke recurrence at a mean follow-up of 6.1 months; one patient had transient mild tongue deviation.

Conclusions:

• Carotid endarterectomy (CEA) is a safe and feasible surgical option for symptomatic carotid webs.
• CEA should be considered a viable alternative to carotid artery stenting (CAS) for treating CW.
• Surgical intervention with CEA effectively reduces the risk of recurrent stroke in patients with CW.