Medical Student Campbell University School of Osteopathic Medicine Cary, North Carolina, United States
Introduction: Carotid Webs (CW) are an atypical manifestation of fibromuscular dysplasia, affecting the intimal layer of the carotid artery. This leads to a shelf-like projection within the carotid artery, disrupting blood flow and increasing the risk of thrombus formation in young patients without known cardiovascular risk factors. The relative lack of literature regarding CWs may cause this to be largely underdiagnosed. The goal of this study is to provide clarity regarding the demographic and clinical characteristics of CWs.
Methods: A literature search using the keyword “Carotid Web” was performed using PubMed, Google Scholar and Embase. Variables extracted included, but were not limited to, age, ethnicity, characteristics of the carotid web, symptoms, stroke score, treatment, and outcome.
Results: After screening, 111 papers were included for a total of 850 patients. The mean age was 46.26 10.46 with 60.29% female and 373/494 patients of African American ethnicity. Risk factors were reported in 613 patients, 32.30% of which had hypertension, 20.72% smokers, and 8.97% with hyperlipidemia. In patients who experienced a stroke, 67.43% of the CWs were ipsilateral to the stroke. The average reported NIHSS stroke score was 10.79 5.17. 45 patients received stent only, 68 received endarterectomy only, 27 received thrombectomy only and 122 received medical only, with symptom improvement rates of 100%, 100%, 96.30%, and 75.41%, respectively. The overall rate of stroke recurrence was 19.50%.
Conclusion : This is the largest systematic review of CWs to date. This study provides novel information not only about risk factors and common treatment modalities for CWs, but also the relationship between CWs and stroke. This data may aid physicians in diagnosis of CWs in younger patients who present with stroke-like symptoms and no cardiovascular risk factors. Furthermore, medical treatment alone may not be as effective as stenting or surgical options.
