Treatment of Symptomatic Carotid Webs: Current Evidence and Future Directions

Abstract

Purpose of Review: This literature review aims to summarize current diagnostic and treatment options for symptomatic carotid webs (CaW) and to identify the evidence gaps that need to be addressed. Recent Findings: CaW accounts for approximately 13% of cryptogenic ischemic strokes in patients under 60 years of age, emphasizing their significance as an underdiagnosed cause of cerebral infarction; however, clear guidelines for diagnosis and management are yet to be established. Given the relatively high recurrence rates observed in patients with symptomatic CaW that are treated with medical therapy alone, more aggressive treatments, such as carotid artery stenting (CAS) and carotid endarterectomy (CEA) are increasingly performed as secondary prevention of stroke. Several small, non-randomized recent case studies have suggested that CEA and CAS may be safe and potentially effective. No clear difference in outcomes has been reported between CAS and CEA, and treatment decisions are generally based on each patient’s perioperative risks, antiplatelet tolerability, or preferences. In contrast, evidence for the management of asymptomatic CaW is scarce. Since CaW may cause large vessel occlusion as a first-ever stroke in young people, preventive treatments could in theory be beneficial for patients with high-risk asymptomatic CaW, although this is controversial and needs to be investigated in further detail. Summary: Interventional treatment for symptomatic CaW is a promising option for secondary stroke prevention. Larger, prospective studies are needed to investigate the long-term outcomes and optimal procedural techniques. Improved understanding of asymptomatic CaW prevalence and reliable embolic risk stratification methods are also required.