Bilateral carotid web successfully treated with endarterectomy, a case report

A carotid web is an uncommon vascular anomaly that has been identified as an important cause of ischemic stroke in young patients with no traditional atherosclerosis risk factors. This fibrous membrane present in the internal carotid artery tends to cause turbulent flow and thrombosis. We report a case of bilateral carotid web successfully treated by carotid endarterectomy.

A 36-year-old female patient with a past medical history of non-epileptic seizures due to psychogenic factors and benign paroxysmal positional vertigo was presented to the emergency room with complaints of jerky movements of the right side of the body and then generalized jerky movements for 40 min. Neurological examination was unremarkable; the NIHSS score was 0. The CT scan showed an acute infarction in the right frontoinsular region. Additional imaging revealed a tiny linear defect within bilateral ICAs. Bilateral carotid webs were diagnosed upon cerebral angiogram, and the patient was diagnosed with cryptogenic stroke. She underwent right carotid endarterectomy. Postoperative recovery was uneventful, and the patient was discharged on the 3rd postoperative day. A subsequent left carotid endarterectomy was performed without complications.

Carotid webs play a key role in ischemic strokes, especially among the young patient population. Most are asymptomatic, but some patients have symptoms of TIA or stroke. Current management options include antiplatelet therapy and surgical intervention.

This case highlights the importance of recognizing a carotid web as a potential cause of ischemic stroke and suggests that surgical intervention is warranted in symptomatic patients to prevent recurrent strokes. Further research is needed to optimize management strategies for this condition.