Introduction: Intimal flap-like protrusion of the carotid artery is referred to as a carotid web (also known as carotid diaphragm and atypical fibromuscular dysplasia) that can cause recurrent ischemic stroke. We retrospectively studied the prevalence, demographics, clinical presentation, and imaging features of all patients in a series with defined carotid webs, and describe the treatment and histopathology of two that were symptomatic.
Methods: This retrospective study analyzed data from a series of 505 patients who underwent head and neck computed tomography angiography (CTA) at Kyoto University Hospital between April 2011 and Oct 2016. Reports have indicated that CTA is reliable for detecting carotid webs, which are defined on images of oblique sagittal sections as a thin intraluminal filling defect along the posterior wall of the carotid bulb. Ultrasonic echo and MRI findings were also matched when available. Carotid webs were finally defined by interpretation of CTA images by a radiologist and an experienced neurosurgeon.
Results: The prevalence of carotid webs in this series was 1.8% (9 of 505 patients), the mean age was 56 (range, 42 - 67) years, and six patients were women. Two (22.2%) of the nine patients with carotid webs had recurrent stroke and both were treated radically by carotid endarterectomy. The histopathological findings suggested fibromuscular dysplasia accompanied by early atherosclerotic changes.
Conclusions: The prevalence of carotid webs was low and they tended to occur more frequently among women in the present series. An optimal management strategy has not yet been devised. However, recurrent ischemic stroke might be caused by turbulent blood flow at the point of recess that leads to the formation of thrombus and emboli. We recommend that such patients undergo radical treatment.