Carotid web as a risk factor for large stroke: Prevalence in consecutive carotid endarterectomy cases

Background: Carotid web (CW) is an intraluminal, ridge-like projection arising from the posterior wall of the carotid bifurcation. It is recognized as a risk factor for ischemic stroke and has been increasingly identified as a potential cause of recurrent embolic strokes of undetermined source (ESUS). However, the relationship between CW and stroke size, as well as how CW compares with internal carotid artery stenosis (ICAS), remains unclear. Methods: A retrospective analysis was conducted of 98 patients who underwent carotid endarterectomy (CEA) for symptomatic ICAS or CW. Demographics, stroke size, and the presence of thrombus associated with CW were evaluated. Diffusion-weighted magnetic resonance imaging and carotid angiography were used to assess stroke size and identify CW. Results: The prevalence of CW in the cohort was 5.1%. Patients with CW experienced significantly larger strokes compared with those with ICAS ( P = 0.006). In addition, 40% of CW lesions were accompanied by thrombus formation, suggesting an increased likelihood of larger infarctions and recurrent events. Conclusion: Compared to ICAS, CW was associated with larger embolic strokes, and its frequent association with thrombus formation further elevates the risk of recurrence. In patients presenting with larger infarctions, careful evaluation of the carotid artery is warranted to identify potential CW.