Carotid artery stenting in a stroke patient with carotid web: a possibly safe treatment

Abstract

Introduction: Carotid web (CW ) is a shelf-like luminal protrusion of the intimal layer of the carotid artery, mostly located in the posterior wall of the carotid bulb. It is a rare pathologic finding and an underrecognized cause of stroke. It can be detected on computed tomography angiography (CTA) or digital subtraction angiography (DSA) and treatment options include medically management and carotid revascularization with carotid endarterectomy (CEA) or carotid artery stenting (CAS). CEA is the therapy generally chosen by physicians. The aim is to report a patient with ischemic stroke and CW who was successfully treated with CAS. Case description: A 46-year-old female, current smoker with no comorbidities, was referred to a tertiary hospital in stroke protocol. Two months prior, she started with headache and visual blurring, evolving with reduced strength, hypoesthesia on the right side of the body and speech alteration. She was lucid and the National Institutes of Health Stroke Scale on admission was 3. She presented mild dyslalia and comprehension impairment, in addition to hypoesthesia in the right hemiface and right hand. Reflexes and muscle strength were normal on all four limbs. Her skull computed tomography demonstrated left temporoparietal hypodensity. A CTA and DSA were performed, revealing a shelf-like filling defect along the posterior wall of the bulb of the left internal carotid artery, characteristic of CW. She was treated with dual antiplatelet treatment and statin before she underwent a CAS with placement of a stent at the origin and proximal segment of the left internal carotid artery, seven days after the ictus. There were no complications and the patient was discharged two days after the procedure with the same drugs. Conclusion: Stent placement can be a safe treatment option for carotid web.