Surgical Treatment of Carotid Webs in Symptomatic Young Adults

Background: Carotid webs are possibly responsible for ischemic stroke in young adults. We aim to report a case series study about surgical treatment of this uncommon condition. Methods: We performed a retrospective analysis on clinical, imaging, pathological, operative data, and outcomes about consecutive patients affected with carotid ischemic stroke due to carotid webs in a single institution. Results: During a three-year period, a total of 123 patients were treated for carotid stroke, in five cases (4%) (median age 48.4 years, range 44-53, 2 men and 3 women, median NIHSS score 8.4, range 4-17) due to a carotid web. Patients were all Caucasian excepting for one. No severe comorbidities were detected. Preoperatively thrombectomy of middle cerebral artery was needed in three cases. Surgical treatment consisted in web resection and carotid end-to-end anastomosis (3 cases) or web excision and patch angioplasty (2 cases). In-hospital NIHSS score improved postoperatively of more than 2 points (median 3.6, range 2-7) in all cases. No major complications were detected. One patient experienced a local hematoma treated conservatively. At a mean follow-up of 18 months (range 1-35 months), no recurrent stroke nor myocardial infarction nor death were remarked. Conclusions: In young patients presenting with ischemic stroke without neither conventional stroke risk factors nor other possible sources of embolism, a carotid web should be suspected. Surgery guarantees excellent results in prevention of recurrences.