Introduction Carotid Webs (CW) are an atypical manifestation of fibromuscular dysplasia, affecting the intimal layer of the carotid artery. This leads to a shelf-like projection within the carotid artery, disrupting blood flow and increasing the risk of thrombus formation in young patients without known cardiovascular risk factors. The relative lack of literature regarding CWs may cause this dangerous pathology to be largely underdiagnosed. The goal of this study is to provide clarity regarding the demographic and clinical characteristics of CWs.
Methods A literature search using the keyword ‘Carotid Web’ was performed using PubMed, Google Scholar and Embase. Variables extracted included, but were not limited to, age, ethnicity, characteristics of the carotid web, symptoms, stroke score, treatment, and outcome.
Results After screening, 111 studies were included featuring a total of 850 patients. The mean age was 46.26 +/- 10.46 years with 60.29% of patients being female. Among patients for whom ethnicity was reported, 373/494 patients were of African American descent. Risk factors for CW were reported in 613 patients: 32.30% of patients had co-existing hypertension, 20.72% were smokers, and 8.97% had been diagnosed with hyperlipidemia. Among patients who experienced a stroke, 67.43% of the CWs were ipsilateral to the stroke. The average reported NIHSS score was 10.79 +/- 5.17. Insofar as treatment is concerned, 45 patients received stent only, 68 received endarterectomy only, 27 received thrombectomy only and 122 received medical management only, with symptom improvement rates of 100%, 100%, 96.30%, and 75.41%, respectively. The overall rate of stroke recurrence was 19.50%.
Conclusion This is the largest systematic review of CWs to date. This study provides novel information not only about risk factors and common treatment modalities for CWs, but also the relationship between CWs and stroke. This data may aid physicians in diagnosis of CWs in younger patients who present with stroke-like symptoms and no cardiovascular risk factors. Furthermore, medical treatment alone may not be as effective as stenting or surgical options.
Disclosures N. Gupta: None. V. Kasulla: None. A. Shahbandi: None. J. Gendreau: None. R. Singh: None. N. Brown: None. J. Catapano: None. V. Srinivasan: None.
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