Treatment of Carotid Web

Understanding Carotid Web

Carotid web is a thin, circumferential shelf-like filling defect that arises from the posterior wall of the internal carotid artery bulb, visible on CTA or carotid angiography 2
Pathologically, it is considered a variant of fibromuscular dysplasia that can be classified as focal or multifocal 2
It is a known cause of ischemic stroke in younger patients (under 65 years), detected in up to 9.5% of patients under 65 with anterior circulation stroke of unknown cause 2
Platelet deposition can occur in the corrugations of carotid web, forming a nidus for blood flow stagnation and thromboembolism 2

Antiplatelet therapy is recommended for patients with carotid web in the distribution of ischemic stroke and TIA without other attributable causes of stroke 1, 2
Options include Aspirin 81-325 mg daily 1, Clopidogrel 75 mg daily 1, and Aspirin + dipyridamole 25/200 mg daily 1
Medical management with antithrombotic therapy is the first-line treatment, though it's not established whether single antiplatelet therapy, short-term dual antiplatelet therapy, or anticoagulant therapy is superior 3

Carotid stenting or carotid endarterectomy (CEA) may be considered in patients with carotid web in the distribution of ischemic stroke refractory to medical management, with no other attributable cause of stroke despite comprehensive workup 2, 4

Confirm carotid web diagnosis using CT angiography, MR angiography, or invasive angiography with contrast, and rule out other causes of stroke 2, 5
Begin antiplatelet therapy (aspirin 81-325 mg daily or clopidogrel 75 mg daily) 1, 2

Future prospective research comparing medical management with interventional management is needed 3