A Rare Cause in the Etiology of Patients who Underwent Mechanical Thrombectomy: Carotid Web

Background: The Carotid Web (CW) is located in the posterior wall at the orgin of the internal carotid artery or carotid bulb.It is a factor especially blamed in the etiology of young and cryptogenic stroke patients.It may be overlooked if contrast-enhanced vascular imaging is not carefully examined.In recent years, articles have been published about its involvement in large vessel occlusion.We present patients in whom we performed mechanical thrombectomy and found CW in the etiology.Methods: Between 2020 January and 2023 December, patients who underwent mechanical thrombectomy due to anterior system large vessel occlusion and were diagnosed with carotid web in the etiology of stroke were included in the study.The diagnosis of carotid web was made by looking at the images taken from three different angles after the guiding catheter was placed distal to the common carotid artery during the mechanical thrombectomy procedure.Results: CW was detected in 11 (1.03%) of 1070 patients who underwent mechanical thrombectomy.Four patients with missing data and unclear stroke aetiology were excluded from the study.CW-related stroke subtype in our study was present in 7 patients (0.65%).Successful recanalisation (mTICI 2b-3) was achieved in 6 of 7 patients (85.7%).For secondary prophylaxis, carotid stenting was performed in 4 patients with mRS 0-3 who were evaluated for clinical outcome at week 1.Ninetieth day good clinical outcome (mRS 0-2) was 57.1%. Conclusion:Carotid Web may cause large vessel occlusion.In patients undergoing mechanical thrombectomy, the presence of CW in the carotid artery bulb should be checked.Secondary prophylaxis in symptomatic strokes due to CW may be performed by carotid endarterectomy or carotid stenting.