Management Dilemma of an Asymptomatic Carotid Web in a High-Risk Patient: A Case Report

Carotid webs, particularly in high-risk patients, can lead to ischemic cerebral events mainly through thrombus formation. While the management of symptomatic carotid webs is relatively well-established, the management of asymptomatic patients remains poorly represented in the vascular literature. We report the case of a 44-year-old male smoker with a sedentary lifestyle and a strong family history of ischemic stroke who was referred by his general practitioner for routine vascular evaluation. Doppler ultrasound (DUS) of the supra-aortic vessels identified a shelf-like fibrous structure on the posterior wall of the proximal internal carotid artery (ICA) without stenosis or thrombus. Computed tomography angiography (CTA) confirmed the diagnosis of carotid web and excluded intraluminal thrombosis. In the absence of neurological symptoms and given the strong family history of ischemic stroke, antiplatelet therapy with aspirin and intensive lifestyle modification were initiated. This case illustrates the diagnostic and therapeutic challenges associated with the incidental diagnosis of carotid webs in asymptomatic patients.