Carotid web: Imaging Features in CT Angiography and Arteriography

Carotid web (CaW) is a rare and underrecognized high-risk factor for ischemic stroke of undetermined etiology. This pathology is caused by a variant of intimal fibromuscular dysplasia, characterized by an endoluminal fibrous intimal flap projecting from the posterior wall of the internal carotid artery bulb into the arterial lumen that generates flow stagnation and, consequently, thromboembolic events. The most prominent clinical manifestation of CaWs is ischemic stroke, particularly in younger patients without other vascular comorbidities. Current management guidelines include either medical treatment as antiplatelet therapy or anticoagulation or interventional treatment. This case demonstrates a 62-year-old woman undergoing investigation for ischemic stroke. The angiotomographic study revealed a localized membrane-filling defect arising from the posterior wall of the left carotid bulb. In addition, angiography was performed, identifying the filling defect along the carotid artery wall. During the late venous phase, contrast agent retention was observed at the distal end of the carotid web. Anticoagulation treatment was prescribed and the patient remains under outpatient follow-up.