Carotid web is an underestimated cause of recurrent ischemic stroke and has been described by multiple case reports [1–6]. It was first described as a stigma of fibromuscular hyperplasia in 1965[1] followed by similar reports in 1967 and 1968 [2,3], since then it has been described in the literature using other synonyms. In most of the reported cases, the diagnosis of carotid web was based on conventional digital subtraction angiography (DSA) as a translucent endoluminal filling defect. Lenck et al., first reported stenting as an...

Both cases were admitted to our institution in the last two years with history of recurrent stroke confined to a single arterial territory. Ischemic strokes were confirmed by MRI. Computed tomographic angiography (CTA) and contrast enhanced magnetic resonance angiography (MRA) were conducted. The initial diagnosis of the carotid web in both patients was established by CTA as a non calcified shelf like hypodense projection at the ICA bulb prior to DSA confirmation. Patient (1) initially managed conservatively with medical therapy (figure 1) while Patient (2)...

Both patients were independent with mRS (modified Rankin score) 0-1 with no recurrent neurological symptoms, TIAs or strokes. Doppler ultrasound studies confirmed patency of the carotid stents with no residual or in-stent stenosis/thrombosis.

Carotid artery webs may be an underestimated though rare cause of recurrent thromboembolic stroke in young and middle age adults despite antiplatelet therapy. CTA may assist in identification, but DSA remains the gold standard for diagnosis of a carotid web. Carotid stenting appears to be a viable alternative to open surgical management for secondary stroke prevention.

Elmokadem AH1,2, Ansari SA2,3,4, Prabhakaran S3, Shaibani A2,4, Hurley MC2,4 1Department of Radiology, Mansoura University, Dakahlia, Egypt. 2Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA 3Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. 4Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Corrosponding author: [email protected] Submitting author: [email protected]

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