Carotid revascularization is associated with reduced recurrence in symptomatic carotid web

Carotid artery web is a rare and underrecognized cause of ischemic stroke. Current literature emphasizes their underdiagnosis and association with high recurrence rates despite medical management. We report a single-center experience of carotid revascularization in patients with ischemic stroke and ipsilateral carotid webs.

This retrospective case series includes 20 patients who presented with acute strokes attributed to ipsilateral carotid webs and subsequently underwent carotid revascularization at a Comprehensive Stroke Center between January 2015 and December 2025. Data on demographics, clinical presentation, and imaging findings were collected via chart review. Descriptive statistics summarize patient characteristics and outcomes.

Twenty patients with ischemic stroke and ipsilateral carotid artery web underwent carotid revascularization. The median age was 54 years (IQR: 45-62), and 70% were female. Median NIHSS was 9 (IQR: 5-15). Fifteen (75%) underwent mechanical thrombectomy and 8 (40%) received IV thrombolysis. Fifteen (75%) had carotid web on the right side. Revascularization was performed for stroke recurrence (30%), superimposed thrombus (25%), or secondary prevention (60%), with overlapping indications. TCAR was the most common approach (65%), followed by CAS (20%) and CEA (15%). Over a median follow-up of 9 months (IQR: 6-21), no patients experienced recurrent ischemic stroke in the treated vascular territory, suggesting potential effectiveness of revascularization in preventing recurrence in selected patients with carotid webs.

Our study highlights the significance of early detection and intervention. All forms of carotid revascularization, including TCAR, have shown effectiveness and safety. However, larger studies are essential to validate these findings.