Symptomatic carotid web management: A prospective single-center cohort study
Donia Soulimani1, Ruben Tamazyan2, Maxime Raux3
1Vascular Medicine Department, Saint-Joseph Hospital, Paris, France.
Vascular Diseases (Paris, France)
|May 25, 2026
Summary
Carotid web (CaW) is a cause of ischemic stroke (IS). Medical management alone led to recurrent IS, while interventions prevented further events, suggesting combined approaches are superior for symptomatic CaW.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Carotid web (CaW), a form of focal intimal dysplasia, is implicated as a cause of embolic ischemic stroke (IS).
- The optimal treatment strategy for symptomatic CaW remains undetermined.
- This study addresses the clinical course and management of patients with CaW-related IS.
Purpose of the Study:
- To evaluate the outcomes of different therapeutic approaches for symptomatic carotid web (CaW).
- To determine the efficacy of medical management versus interventional strategies in preventing recurrent ischemic stroke (IS).
Main Methods:
- A prospective, single-center observational cohort study included 32 patients hospitalized for IS with confirmed CaW.
- Patients were followed prospectively from January 2016 to April 2024.
- Data on clinical presentation, diagnostic imaging, treatment, and follow-up outcomes were collected.
Main Results:
- Recurrent IS occurred in 19% of patients on antiplatelet therapy (APT) alone.
- Interventional procedures (carotid endarterectomy or angioplasty with stenting) were performed in 29 patients with no major complications.
- No ischemic recurrence or death was reported post-intervention during a mean follow-up of 24 months.
Conclusions:
- Medical management alone for symptomatic CaW is associated with a risk of recurrent ischemic stroke (IS).
- A combined interventional approach effectively prevents cerebrovascular events in patients with CaW.
- Further randomized trials are necessary to establish the preferred revascularization strategy.
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