Introduction: Carotid webs are shelf-like protrusions that form as a result of a developmental abnormality. Studies suggest a prevalence of up to 37% of cryptogenic stroke patients. Diagnosis is based on stroke symptomatology in the absence of traditional risk factors, and identification on CTA axial cut. Currently, the vast majority of cases undergo surgical resection. Our case report describes the diagnosis and stenting of a carotid web with favorable outcomes in an African American female.
Methods: A 33-year-old African American female presented to the ED complaining of left hemiparesis and left facial droop. The patient did not have a significant past medical history including those predisposing for stroke. Initial physical examination showed left facial asymmetry, left upper extremity pronator drift, and left lower extremity weakness with a calculated NIHSS of 3. CTA showed an occlusion of M2 of the right MCA, and a carotid web at the carotid bulb visualized on axial and coronal cuts. Aspiration thrombectomy resulted in TICI 3 score, and double antiplatelet therapy was prescribed. Stenting of the carotid web was performed three weeks later. The patient returned for a two-week follow-up with complete resolution of her neurological symptoms.
Results: This is the third reported case of carotid web stenting. Carotid webs are frequently underdiagnosed in patients presenting with stroke symptoms in the absence of the most common stroke risk factors. Diagnosis is made secondary to CTA imaging, particularly the axial cut. Surgical resection has been widely described in literature as the preferred method of treatment for carotid webs, but little has been reported on stenting techniques for this pathology.
Conclusions: Carotid webs are increasingly suspected in cryptogenic strokes. We report the third existing case of carotid web successfully treated with stenting, and the first in an African American female patient.
Patient Care: It is the hopes of these authors, that our case and the unique management of a carotid web with successful stenting should suggest a role for endovascular treatment in this pathology.
Learning Objectives: By the conclusion of this session, participants should be able to discuss the typical presentation, diagnosis, natural history and accepted treatment for carotid webs in the setting of stroke. We discuss a relatively common presentation of carotid web djscovered during diagnostic imaging in a young African American female following stroke. However, the treatment of this patient with endovascular stenting as opposed to open surgery makes her management unique, with only 3 additional cases of stenting being documented in the literature.