Outcomes after carotid revascularization for symptomatic carotid artery web: A multi-institutional cohort study

Objective Carotid web can serve as a nidus for clot formation and subsequent thromboembolic stroke. Although treatment historically involved antiplatelet therapy, recent evidence demonstrates notably elevated recurrent stroke rates despite best medical therapy. We examined the safety and efficacy of carotid artery stenting (CAS), which involves placing a coil in the artery, and carotid endarterectomy (CEA), a surgery to remove the clot, for treatment of symptomatic carotid web. Methods A multi-institutional retrospective registry including adult patients with carotid web with history of ipsilateral acute ischemic stroke or transient ischemic attack (TIA) treated with either carotid artery stenting or endarterectomy was reviewed. Patient demographics, comorbidities, clinical presentation, treatment methodology, and outcomes at follow up were collected. Results Among the 71 included patients (mean age 52.4 years, 44 (62.4%) female), 23 (32.4%) underwent CEA, and 48 (67.6%) underwent CAS. The most common presenting symptoms were hemibody numbness/weakness, aphasia, and gaze deviation. On average, patients had experienced 1.12 ± 0.7 strokes or TIAs before intervention, with a mean delay of 115 ± 224 days between initial stroke/TIA and intervention. The median preintervention modified Rankin Scale (mRS) score was 2. Perioperatively, one patient (1.41%) experienced stroke and none experienced myocardial infarction. During mean 14.8 (±29.2)-month follow up, one patient experienced asymptomatic recurrent stroke (1.41%). Median mRS at follow up was 1, and carotid artery stenting and endarterectomy demonstrated similar rates of postoperative complication and recurrent stroke rates. Conclusion Our results suggest that endarterectomy and stenting are safe and efficacious for minimizing subsequent stroke risk in patients who have experienced stroke or TIA from carotid webbing, warranting further studies to determine the optimal timing and method of treatment.