Describe safety and short-term clinical and imaging outcomes after carotid artery stenting (CAS) for symptomatic carotid web.

Carotid web, a shelf-like intimal projection at the internal carotid artery bulb, is an underrecognized cause of embolic stroke in young individuals. Observational data indicate a high rate of recurrence with medical therapy, while revascularization procedures, such as endarterectomy and CAS, seem to reduce this risk. Case series of CAS show a high rate of technical success and low complications.

Retrospective single-center case series of adults who experienced strokes and were found to have an ipsilateral carotid web identified on CTA/DSA imaging, undergoing CAS. We collected data on demographic, therapeutic, clinical, and radiographic variables at the time of diagnosis and during follow-up. The analysis was descriptive.

Five young patients (median age 47 [IQR 29.5–53], 40% women) presented with embolic-appearing infarcts (40% LVO) and ipsilateral carotid web; median stenosis was 40% [IQR 35 - 67.5], and NIHSS scores median 4 [IQR 3-5]. All patients received aspirin plus clopidogrel before the procedure. Carotid artery stenting was performed a median of 114 days (73–140) from the index stroke; IV thrombolysis was used in 1/5. Technical success was 5/5; and balloon expansion was required in 3/5 to optimize stent apposition. Two patients developed mild vasospasm, which was successfully treated with IA nitroglycerin. At 90 days, functional outcomes were favorable (mRS 0–1 in 5/5), and during imaging follow-up, there were no recurrent ischemic events, no ICH, and no in-stent restenosis

CAS for carotid web in young stroke patients appears feasible and safe, showing good 90-day outcomes and early vessel patency; consistent with prior reports, revascularization is reasonable when an embolic mechanism is likely, though larger prospective studies are needed.