Atypical Fibromuscular Dysplasia of the internal carotid artery or Carotid Web (CW) is a rare lesion with an estimated prevalence of 1.6% 1 characterized by a shelf like flap extending into the internal carotid artery and is found to be highly thrombogenic leading to recurrent acute ischemic stroke of the anterior circulation in up to 70% of cases and 30% if treated with medical therapy only. Despite the high cerebral embolic risk, there are no recommendations on the management of the CW. In this study we report our single center experience with Carotid Artery Stenting (CAS) and the outcomes over a 2-year follow-up.

We retrospectively investigated all CAS cases performed in a single center between 2015 and 2020 Identifying all patients treated for CW. The diagnosis of CW was made when when a thin intraluminal filling defect along the posterior wall of the carotid bulb visible as a septum on axial imaging was identified on computed tomography angiography (CTA) and officially confirmed by a team of Neurologists and Neuroradiologists. Patient demographics, medical history, and clinical outcomes were collected and described using descriptive statistics. All patients were followed up with Dupplex Ultrasound after 3, 12, and 24 months from the day of intervention.

In the study period, a total of 308 CAS cases were performed in a single institution. We identified 7 patients with CW, all of whom were admitted for anterior circulation ischemic stroke and were referred to the Vascular Surgery department for treatment. The median age was 43.5 ± 10.3 years and 6 out of 7 were females. Three patients suffered from a single ipsilateral ischemic stroke while 4 experienced ipsilateral recurrent stroke . Two patients had bilateral CW. Dual layer nitinol carotid stents were used in all cases. There were no procedure related complications. During the 24 month follow-up, non of the patients developed ipsilateral stroke.

Despite their infrequency CW are highly thrombogenic. Early diagnosis and treatment can significantly reduce risk of ischemic stroke in this population. CAS appears to be a safe and durable option in the management of CW however larger studies are required to confirm these findings.

1. Mei J, Chen D, Esenwa C, et al. Carotid web prevalence in a large hospital-based cohort and its association with ischemic stroke. Clin Anat. 2021;34(6):867-871