Treatment of a Symptomatic Carotid Web: A Case Report and Review of the Literature

A carotid web is identified as an atypical variant of fibromuscular dysplasia. It is characterised by fibrotic, non-atherosclerotic bands found in the carotid artery intima, forming a shelf-like intraluminal web that, in most cases, lies on the posterior wall of the carotid bulb or the proximal internal carotid artery. That shelf formed a site for thrombus accumulation, with a significant risk of further distal embolisation to the cranial circulation, leading to recurrent thromboembolic stroke and transient ischaemic attack. In this case report, a 48-year-old male presented with recurrent transient ischaemic attacks and stroke despite being on the best medical treatment in the form of dual antiplatelets and a high dose of statins. During the most recent event, he presented with left-sided weakness and slurred speech and underwent urgent thrombolysis with full recovery, then was referred to the vascular surgery department. During his workup investigations with carotid duplex and computed tomographic angiography, a carotid web was identified on the posterior wall of the proximal internal carotid artery with 50% stenosis. As per the recent literature consensus and guidelines, due to recurrent symptomatic events despite medical therapy, he was scheduled for carotid endarterectomy with bovine patch repair in the nearest slot.