A case report of bilateral carotid web: a rare occurrence

Abstract

A carotid web is considered a localized form of fibromuscular dysplasia, carrying a heightened risk of stroke due to blood stagnation and subsequent clot formation downstream from the web. These abnormalities typically affect the rear outer wall of the carotid artery, and their exact developmental origin remains a topic of debate. This case report details the presentation of a young male with altered mental status, ultimately diagnosed with an acute stroke using magnetic resonance imaging (MRI). Brain MRI revealed an ischemic stroke affecting the distribution of the left middle cerebral artery (MCA), with linear filling defects resembling shelves in the carotid bulbs on a computed tomography angiography (CTA) of the head and neck, consistent with bilateral carotid web confirmed by catheter angiography. Bilateral carotid web cases are also relatively uncommon in clinical practice but should not be dismissed as a potential cause of unexplained strokes. Bilateral carotid webs were identified using head and neck CTA, cerebral angiography, and carotid artery Doppler ultrasound. The patient was then treated with enteric-coated aspirin, clopidogrel, and high-intensity statins, followed by carotid endarterectomy after a 2-month follow-up, revealing fibromuscular hyperplasia upon pathology examination.

Keywords

bilateral carotid web / stroke / doppler ultrasound