Recordings from the 2025 Neuro-APP Symposium-Unraveling The Web Carotid Web As A Rare Cause Of Stroke In The Young

Unraveling The Web Carotid Web As A Rare Cause Of Stroke In The Young

Video Transcription

Video Summary

A neurology physician assistant presents carotid web as an underrecognized cause of ischemic stroke, especially in younger patients with otherwise cryptogenic, anterior-circulation strokes. A web is a shelf-like projection from the posterior internal carotid artery bulb—not a typical atherosclerotic narrowing—that may disrupt blood flow and promote clot formation and embolism. It is reported more often in women and African-American patients, and may occur on both sides.<br /><br />Diagnosis relies mainly on CTA, with oblique and multiplanar views; MRA can also help, while ultrasound is an adjunct. The speaker encourages clinicians and radiologists to consider the diagnosis when evaluating younger stroke patients.<br /><br />Treatment guidance remains limited. Antiplatelet therapy is used, but recurrence appears higher with medical management alone. Carotid stenting or endarterectomy may be considered for symptomatic webs, depending on specialist preference. A case of a 40-year-old woman with a severe stroke illustrates successful endarterectomy and recovery.

Keywords

carotid web

ischemic stroke

cryptogenic stroke

internal carotid artery

computed tomography angiography

endarterectomy