Abstract
Abstract Introduction Carotid webs are a rare form of focal fibromuscular dysplasia and a possible cause of ischaemic stroke. They are defined as an abnormal shelf-like projection of intimal fibrous tissue into the carotid bulb. We reviewed patients found to have carotid webs at our unit over a 12-year period. Methods Radiology reports of all cross-sectional imaging from 2010-2021 were searched for the phrase carotid web. Images were reviewed to confirm the finding. Patients with previous carotid intervention were excluded. Electronic patient records were reviewed to establish presenting symptoms, diagnosis, management and stroke recurrence. Results 60 patients with carotid webs were identified. Ages ranged from 36-92 years. The gender ratio was 31 male:29 female. 29 patients had left-sided carotid webs, 22 right-sided and 9 bilateral. No patients had a pre-event diagnosis of fibromuscular dysplasia. 27 patients had an ischaemic intracerebral event - 18 in the territory relevant to the web location and nine in other territories. 1 patient was treated with thrombolysis, 1 with thrombectomy and 1 with thrombolysis and thrombectomy. None underwent carotid intervention. Of the 18 patients with a carotid web on the ipsilateral side to their ischaemic event, none had a repeat event recorded. Conclusion 30% of patients had an ischaemic event corresponding to the territory supplied by a carotid artery with a web. Current management of carotid webs favours conservative management with antiplatelet therapy. However, these data suggest carotid intervention should be considered in selected patients where stroke symptoms correlate to the laterality of the carotid web.
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