Surgical Management of Symptomatic Carotid Artery Webs

Abstract

Objective

To demonstrate the demographic profile and postoperative outcomes among a large single-center series of patients undergoing carotid endarterectomy for carotid web.

Background

Carotid artery web (CaW) is a shelf-like intraluminal lesion at the carotid bulb that produces stagnant flow and can result in cerebrovascular ischemia among young and otherwise healthy individuals. While there is no consensus on the ideal management strategy for CaW with ipsilateral stroke, emerging evidence favors open surgical intervention. We present a large single-center experience of carotid endarterectomy for CaW.

Methods

Single-center retrospective review of all patients admitted between January 2016 and September 2023 with acute ischemic stroke, had CT angiography findings consistent with CaW- shelf-like projection at the level of the carotid bulb- and underwent carotid endarterectomy. The main outcome variables were ipsilateral stroke or transient ischemic attack during the follow-up period.

Results

Twenty-three patients who underwent carotid endarterectomy for CaW were identified. The median age was 41 years old [IQR 38 – 47], 19 were female (82%), and 21 were African American (91%). One patient was originally managed with medical therapy alone and presented with recurrent stroke. All patients underwent carotid endarterectomy at a median of 29 days after presentation. Patch angioplasty was used in 16 (70%) patients, 15 with bovine pericardial patch and one with collagen-impregnated polyester patch. The arteriotomy was closed primarily in the other 7 patients. Eleven (48%) patients had mobile thrombus associated with the web present on imaging or surgical exploration. No new cerebrovascular events occurred in the follow-up period, a median of 154 days.

Conclusion

Carotid endarterectomy is an established procedure that can be applied to the treatment of carotid web in the setting of associated ipsilateral cerebrovascular ischemia. The procedure is associated with minimal complications and demonstrates an absence of recurrent ischemic events at short and medium-term follow-up.