Carotid endarterectomy effectively treats carotid webs： A case report

Abstract

A carotid web is a rare condition that causes vascular stenosis secondary to localized fibromuscular dysplasia of the internal carotid artery (ICA). We report a case of a symptomatic carotid web successfully treated with carotid endarterectomy (CEA). A 70‒year‒old woman presented with sudden onset of left hemiparesis. Mechanical thrombectomy performed after tissue plasminogen activator administration achieved successful recanalization of the occluded right middle cerebral artery. Digital subtraction angiography revealed mild stenosis at the origin of the right ICA. Ultrasonography performed on the 6th day of hospitalization revealed a mobile thrombus, and we performed emergency CEA, and the carotid web and soft and mobile thrombus were removed. The patient’s postoperative course was uneventful, and she showed no recurrent thrombosis of the right ICA. Owing to the structural abnormality and consequent blood flow stasis associated with a carotid web, this condition predisposes patients to thrombosis and embolism. Although standardized treatment has not been established for carotid webs, studies have reported that pharmacological treatment alone is associated with a high risk of recurrent cerebral infarction, and surgical treatment should be considered at an early stage.