Carotid Web Stenting After Mechanical Thrombectomy: How Long Should We Wait? A Case Report and Review of Literature
Noelia Morales-Cardona 1, Cesar Escamilla-Ocanas1, Omar Tanweer2, Ravi Shastri3
1Department of Neurology, Baylor College of Medicine, Houston Texas, 2Department of Neurosurgery, Baylor College of Medicine, Houston Texas, 3Division of Neurointerventional Radiology, Department of Radiology, Baylor College of Medicine, Houston, Texas
Objective:
In this study, we present a case of carotid artery stenting following endovascular thrombectomy (EVT) on a patient with symptomatic carotid web.
Background:
A carotid web is an intraluminal shelf-like projection that arises from the carotid bifurcation and is increasingly recognized as a cause of recurrent ischemic stroke. Carotid artery stenting has recently emerged as a viable treatment option; however, the optimal timing for intervention following acute ischemic stroke remains controversial in the literature.
Results:
A 43-year-old male with no medical history presented with sudden onset left-sided weakness, numbness, and dysarthria, last known normal reported 4 hours prior to presentation. Initial National Institute of Health Stroke Scale (NIHSS) score was 10. CTH revealed a chronic appearing right MCA infarct involving M4 and M5 segments, but no evidence of acute ischemia or hemorrhage. Thrombolysis with alteplase was administered. CTA showed a right MCA occlusion at M1 segment, and CTP showed an 8mL core and 155 mL penumbra. The patient underwent EVT with a TICI 2b reperfusion. Digital subtraction angiogram (DSA) revealed evidence of a right proximal ICA carotid web, and further investigation did not reveal any other stroke etiology. Seven days post-stroke, the patient underwent successful placement of a 10 - 8 mm X 40 mm Xact carotid stent with no complications. The patient was discharged with a NIHSS score of 1 and DAPT.
Conclusions:
Treatment options for symptomatic carotid web include interventional therapy with carotid stenting or endarterectomy versus medical therapy. Previous studies have shown a high risk of recurrent stroke despite maximal medical management. In this study, we present a young patient with no traditional stroke risk factors who underwent successful stenting seven days after stroke. Considering the elevated risk of stroke recurrence, early stenting could be a safe and feasible option for secondary stroke prevention in patients with carotid web.