Carotid Webs and Stroke: A Comprehensive Overview of Clinical Characteristics, Risk Factors, and Treatment Modalities Publisher Pubmed



Gupta N¹ ; Patel S² ; Khan MF³ ; Brown NJ⁴ ; Gensler R⁵ ; Kasula V¹ ; Bhatt A⁴ ; Singh R⁶ ; Shahbandi A⁷ ; Gendreau J⁸ ; Sahyouni R⁴ ; Rahmani R⁹ ; Khalessi AA⁴
Source: Journal of Clinical Neuroscience Published:2025

Abstract

Introduction: Carotid web (CW) refers to an atypical manifestation of fibromuscular dysplasia that affects the intimal layer of the internal carotid artery (ICA) and carotid bulb. CWs involve a shelf-like intraluminal projection within the ICA, increasing the risk of thrombus formation in young patients without known cardiovascular risk factors. The relative lack of literature regarding CWs may cause this pathology to go largely underdiagnosed. Hence, the goal of this study is to provide clarity regarding the demographic and clinical characteristics of CWs. Methods: A literature search was performed using PubMed, Google Scholar, and Embase in accordance with PRISMA guidelines. Variables extracted included patient age, ethnicity, CW characteristics, symptomatology, NIHSS stroke score, relevant intervention(s), and outcomes associated with each intervention. Results: After the full-text screening, 109 studies comprising 788 patients met pre-defined criteria for inclusion in the present review. The mean age of patients across all studies was 46.26 ± 10.46 years. Additionally, a majority (60.79 %) of patients were female, and a substantial percentage of the cohort (79.95 %) identified as African American. Of the 788 patients included, 61.55 % experienced ischemic stroke, with the majority affecting the middle cerebral artery territory. The average reported NIHSS score for all patients was 10.79 ± 4.75. Concerning intervention modality, 49.14 % of patients received medical treatment, and 31.70 % underwent microsurgical management. A small percentage underwent endovascular procedural intervention, as stenting was used in 16.71 % of patients. Overall, the CW recurrence rate was 17.73 %. Interestingly, all patients managed via endovascular stent placement or microsurgical endarterectomy experienced symptomatic improvement without recurrence. Conclusion: This study provides novel information regarding relevant risk factors and common treatment modalities for CWs. These findings may aid physicians in diagnosing and treating CWs in younger patients who lack known cardiovascular risk factors and present with stroke-like symptoms. Our findings suggest that medical management alone may not be as effective as endovascular or microsurgical interventions. © 2025 Elsevier Ltd