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Pathologically Confirmed Symptomatic Carotid Webs: Histopathological Features and Long-Term Surgical Outcomes.

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Carotid webs cause ischemic stroke in young adults. Carotid endarterectomy (CEA) is a safe and effective treatment, confirmed by pathology, with no recurrent strokes in a long-term study.

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Area of Science:

  • Vascular Surgery
  • Neurology
  • Pathology

Background:

  • Carotid webs are an underrecognized cause of ischemic stroke in young adults.
  • Medical therapy alone has a high risk of recurrence for symptomatic carotid webs.
  • Histopathological confirmation of carotid webs after carotid endarterectomy (CEA) is infrequently reported.

Purpose of the Study:

  • To present the largest pathologically confirmed series of symptomatic carotid webs treated with CEA.
  • To provide a comprehensive clinicopathological characterization of symptomatic carotid webs.
  • To evaluate long-term surgical outcomes after CEA for carotid webs.

Main Methods:

  • Retrospective identification of patients with symptomatic carotid webs.
  • Analysis of clinical features, imaging, surgical findings, and histopathological results from CEA specimens.
  • Presentation of the largest pathologically confirmed series of symptomatic carotid webs treated with CEA.

Main Results:

  • 34 of 39 patients had histopathological confirmation of carotid webs via CEA.
  • Webs were characterized by intimal fibromyxoid tissue, fibromuscular dysplasia, or thickening, located near the carotid bifurcation.
  • At 29-month follow-up, no recurrent strokes occurred, and functional outcomes were favorable (mRS=1).

Conclusions:

  • Carotid endarterectomy (CEA) is a safe and effective treatment for symptomatic carotid webs.
  • CEA provides definitive histopathological diagnosis of carotid webs.
  • This study defines the vascular pathology of carotid webs and supports surgical resection for diagnosis and treatment.