Carotid webs management in symptomatic patients

Area of Science:

• Vascular Surgery
• Neurology
• Cardiovascular Medicine

Background:

• Atypical fibromuscular dysplasia (AFMD), or carotid web, is a rare cause of cryptogenic stroke.
• It presents as fibrous tissue in the carotid artery bulb, leading to embolization and stroke.
• Current management strategies for AFMD, especially bilateral lesions, lack clear recommendations, with medical treatment alone showing unsatisfactory outcomes.

Purpose of the Study:

• To evaluate the outcomes of surgical intervention for symptomatic AFMD.
• To determine the efficacy of open surgery versus stenting in managing AFMD.
• To assess the recurrence rates and complications associated with AFMD treatment.

Main Methods:

• Retrospective review of 11 patients (median age 41) with symptomatic AFMD treated between January 2016 and April 2019.
• Patients underwent either open surgery (endarterectomy or resection-anastomosis) or carotid artery stenting.
• Diagnosis was confirmed histologically; 30-day and 1-year outcomes were analyzed.

Main Results:

• 16 AFMD lesions were treated: 13 by open surgery and 3 by stenting.
• One complication occurred after stenting (external iliac rupture), while open surgery had no perioperative complications.
• All patients experienced uneventful 30-day and 1-year follow-ups, with no deaths or recurrent strokes.

Conclusions:

• Symptomatic AFMD is a rare but significant cause of cryptogenic stroke, frequently occurring bilaterally.
• Early surgical intervention, with open surgery as the preferred first-line option, is associated with favorable outcomes in young patients.
• Surgical management of AFMD offers a promising alternative to medical treatment, significantly reducing stroke recurrence.