ISCHEMIC STROKE
Carotid artery web
Created 12/01/2022, last revision 21/04/2023
Definition
- the carotid artery web is increasingly recognized as an important cause of (recurrent) ischemic stroke in patients without other cardiovascular risk factors
- it is a thin membrane extending from the posterior wall of the carotid artery bulb into the lumen just above the bifurcation and is considered a variant of fibromuscular dysplasia [Kim, 2019]
- various synonyms are used: carotid weblike formation, carotid pseudovalvular fold, carotid diaphragm
- a relatively rare vascular pathology with thrombogenic potential (due to blood stasis along the downstream surface of the web), which can lead to intracranial thromboembolism [Compagne, 2019]
- a significant risk factor for cryptogenic and recurrent ischemic stroke (the incidence rate of carotid web in cryptogenic stroke is 8.9% vs. 1.9% in the control group) [Coutinho, 2017]

Epidemiology
- a relatively rare finding (approximately on 1-2.5% of CTAs performed) (Coutinho, 2017) [Compagne, 2017]
- more common in women
Clinical presentation
- often an asymptomatic, incidental lesion
- thrombus formation can lead to recurrent stroke/TIA
- recurrence occurs in up to 29% of patients despite medical treatment [Haussen, 2019]
- the web is a significant cause of “cryptogenic stroke” in young patients
Diagnostic evaluation
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Management
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