Treatment of Symptomatic Carotid Webs.

ABSTRACT

BACKGROUND: The present study aims to describe the clinical characteristics and treatment outcomes of patients with symptomatic carotid web treated at a single institution in South America. METHODS: Retrospective study of a single-center experience of patients with carotid webs surgically treated from September 2019 to September 2023. RESULTS: Ten patients had carotid webs, 6 (60%) were females. Median age was 54.5 years (range 35-77 years). All patients were symptomatic. Diagnosis was made in 90% (n = 9) of the patients with either computed tomography angiography or magnetic resonance alone. One (10%) patient underwent angiography for definite diagnosis. The median interval from the first neurological event to intervention was 90 months (range 3 days-108 months). Four (40%) patients underwent surgical treatment within 1 month from symptom onset and carotid web diagnosis, with a median of 3.5 days (range 3-9 days). Six (60%) patients underwent delayed surgical treatment since the cause of the neurological event was uncertain, with a median of 54 months (range 6-108 months). These 6 patients had recurrent neurological events. Three (30%) patients underwent carotid endarterectomies with polyurethane patch and 3 (30%) by eversion technique. Three (30%) patients underwent segmental resection and reanastomosis of the internal carotid artery. One underwent internal carotid artery plasty with saphenous vein. At a median follow-up of 30 months (range 6-46 months), 1 patient persists with mild aphasia, another patient has severe aphasia and right hemiparesis, both as sequelae of their initial strokes, and another patient has suffered 3 nonischemic episodes of brief transient right hemiparesis attributed to epileptic seizures. The other 7 patients remain without new neurological events. CONCLUSIONS: Neurological events of carotid distribution deserve accurate imaging work up, keeping in mind the diagnosis of carotid web. Surgical treatment for carotid web seems effective for preventing recurrences; nevertheless, further studies are warranted to define the best management for these patients.