Introduction: Carotid web, a subtype of fibromuscular dysplasia, recently gained attention as rare but treatable cause of cryptogenic stroke. The main mechanism involved is artery-to-artery embolism, single antiplatelet does not effectively prevents a recurrent stroke and both endarterectomy and stenting of the affected artery were described as effective preventive tools.
Patients and Methods: Among ischemic stroke patients prospectively enrolled in a hospital-based registry subjects aged 18-45 years from 30 July 2015 to 30 July 2018 were selected. Clinical-demographic data and advanced neuroimaging of head and neck (CTA, MRA, DSA) were examined, searching for carotid web in both carotid arteries irrespectively from the cause of stroke.
Results and Discussion: 72 patients with ischemic stroke aged 19-45 years were identified and 6 among them were found to have a unilateral or bilateral carotid web. Female-to-Male ratio is 2:4 and the mean age is 38.5 years (range 29-45). 3/6 patients have a previous history of cryptogenic stroke in the same vascular territory, 3/6 patients have a bilateral carotid web and only in 1/6 patients carotid web was unrelated to the index stroke. All other causes were investigated and excluded in 5/6 patients and they were treated by carotid stenting on the symptomatic side. In 1/6 patients an incidental finding of early thrombosis superimposed on the carotid web strengthened the causal association with ischemic stroke.
Conclusion: If carefully searched, carotid web may be more frequent than previously known, mainly in young patients with stroke. This finding has a relevant implication in secondary prevention.