Background: Carotid web is a shelf-like lesion in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. Carotid webs have been associated with recurrent strokes and traditionally treated with surgical excision. We report a multicenter experience of stenting in patients with symptomatic carotid webs.
Methods: Retrospective review of patients admitted to three comprehensive stroke centers identified to have a carotid web with otherwise negative stroke workup that underwent stenting. A carotid web was defined by the presence of a shelf-like/linear, smooth filling defect in the posterior aspect of the carotid bulb diagnosed by neck CT/MR angiography and confirmed with conventional angiography.
Results: Twenty patients with symptomatic (80% Stroke/20% TIA) carotid webs were stented. Median age was 48[41-61] years, 7(35%) were male, and 15(75%) Black. Median NIHSS was 11[2-16] while ASPECTS 8[7-8]. Eight (40%) received intravenous thrombolysis and 10 (50%) thrombectomy. All patients were stented on dual antiplatelets (aspirin and clopidogrel or ticagrelor) at a median 9[4-30]days after the last vascular event. Closed-cell stents were used in 75% of cases (XACT  and Wallstent ) while open-cell stents in 25% (Acculink). No cases required angioplasty for residual stenosis had to be performed. DIstal embolic protection was used in 19 cases (SpiderFX and Emboshield_NAV6) while proximal protection in 1 (MoMa). No periprocedural events occurred with the exception of two cases of hypotension/bradycardia (one requiring 24-hour vasopressors). No parenchymal hematomas were observed but one patient developed vaginal hemorrhage requiring discontinuation of one antiplatelet at 2 months. Modified Rankin Scale 0-2 (independence) at 90 days was recorded in 95% of patients. Clinical follow-up post stent occurred for a median of 4 [2-12] months and no follow-up cerebrovascular events were noted. Follow-up vascular imaging was performed in 95% patients at a median of 3[2-12]months and were all unremarkable.
Conclusions: Stenting for symptomatic carotid web appears to be a valid, safe, and effective alternative to surgical piecemeal resection. Further studies are warranted.