Carotid Web as a Cause of Ischemic Stroke: Effective Treatment with Endovascular Techniques

Background: Carotid web (CaW) usually presents as a shelf-like intimal flap at the beginning of the internal carotid artery. It has been proven that CaW is associated with ischemic stroke, particularly in young patients without other risk factors. This case report aimed to describe the carotid web that causes ischemic stroke due to embolic complications. Moreover, both pathologies were successfully treated with endovascular techniques in the presented case study. Methods: A 59-year-old male presented to the neurological department with motor aphasia, right-sided weakness, and hypoesthesia. Computer tomography (CT) of the head and computed tomography angiography (CTA) of the aortic arch and intracranial arteries were performed. Due to the unknown onset of the presented stroke symptoms, diagnostics were extended to magnetic resonance (MR), and based on this, the patient qualified for immediate mechanical thrombectomy (according to the DAWN trial protocol). Intraoperative digital subtraction angiography (DSA) revealed embolism material in the left middle cerebral artery (segment M1). The artery was recanalized via aspiration thrombectomy using the Penumbra system, and complete restoration of flow was obtained (according to the TICI scale). In addition, DSA revealed the presence of CaW changes in the left internal carotid artery (LICA). In the control CT scanning, an acute ischemic area in the left temporal lobe was found. After the treatment, the patient demonstrated complete neurological improvement from his initial presentation. He qualified for carotid artery stenting of the LICA, which was postponed to a later period due to the presence of an area of infarction. The angioplasty with stenting was performed 6 months later, and a carotid antiembolic "mesh" stent (Roadsaver, Terumo) was implanted into the LICA across the carotid web. Conclusions: CaW should be considered in the case of stroke resulting from unknown causes. The presented case study demonstrated that both carotid web and ischemic stroke pathologies can be effectively treated with emerging endovascular techniques.