Recurrent ischemic stroke caused by a carotid web: a case report

A carotid web (CW) is an uncommon, shelf-like intraluminal protrusion arising from the posterior wall of the carotid bulb. Histologically, it is considered a variant of fibromuscular dysplasia and has been increasingly recognized as a potential cause of cryptogenic ischemic stroke. However, its low prevalence and subtle imaging features often lead to diagnostic challenges, resulting in frequent under-recognition or misdiagnosis in clinical practice.

We report the case of a 49-year-old East Asian man who presented with a 13 h history of slurred speech, dizziness, and decreased responsiveness. Brain magnetic resonance imaging revealed an acute infarction in the left frontotemporal lobe. Despite standard antiplatelet therapy, the patient experienced a recurrent cerebral infarction 6 weeks later. Subsequent digital subtraction angiography (DSA) revealed a left carotid web, demonstrating severe stenosis with persistent contrast stagnation. The patient subsequently underwent carotid endarterectomy (CEA), during which the web and its adherent thrombus were completely excised. Postoperative imaging confirmed a patent carotid lumen, and no stroke recurrence was observed during the 1-year follow-up, during which the patient exhibited favorable neurological recovery.

CEA serves as a definitive therapeutic approach for recurrent cerebral infarction secondary to symptomatic CW, enabling complete removal of the pathological substrate and anatomical restoration of the affected vessel. This case underscores the importance of recognizing CW as a potential etiology of recurrent ischemic stroke in patients without conventional cerebrovascular risk factors and highlights the role of comprehensive vascular imaging in facilitating timely diagnosis and individualized therapeutic decision-making.