Abstract TP364: Carotid Endarterectomy for Symptomatic Carotid Webs: Histopathological Features and Clinical Outcomes

Introduction: Carotid webs have recently emerged as an underrecognized cause of ischemic stroke in young adults. Given the high risk of ischemic stroke recurrence with medical therapy alone, carotid endarterectomy (CEA) is frequently performed at our center. In this retrospective study, we describe the clinical characteristics, diagnostic evaluation, histopathological findings, and long-term outcomes of patients with pathologically confirmed symptomatic carotid web. Methods: Patients were identified through an institutional database of individuals with symptomatic and asymptomatic carotid webs who received inpatient or outpatient care at our centers. Due to the rarity of the condition and the resulting small sample size, only descriptive analyses were performed. Results: Among 39 patients with symptomatic carotid web, 34 underwent CEA with histopathological confirmation of the diagnosis, characterized by focal eccentric intimal fibromyxoid tissue, fibromuscular dysplasia, hyperplasia, or thickening (Table 1). All webs were located within 3 cm of the carotid bifurcation, and most (76%) were localized on the posterior wall. Bilateral carotid webs were identified in 18% of patients (Table 2). Two-thirds of patients presented with a large or medium vessel occlusion and over half received acute reperfusion therapy (intravenous thrombolysis and/or mechanical thrombectomy). Two patients experienced transient, minor cranial nerves injuries (hypoglossal nerve and marginal mandibular branch) following CEA. At a median follow-up of 27 months, no patients experienced recurrent stroke (95%CI:0-10%), and the median modified Rankin Scale score was 1 (0-1). Conclusions: These findings highlight the diagnostic and therapeutic utility of CEA in patients with symptomatic carotid web. CEA offers not only a safe and effective revascularization strategy but also the opportunity for definitive histopathological confirmation.