Carotid Web: A Practical Approach to Diagnosis, Risk Assessment, and Management
Carotid web (CaW) is a nonatherosclerotic vascular anomaly and an underdiagnosed cause of embolic ischemic stroke, particularly in young patients without traditional vascular risk factors. Its intraluminal position and morphology produce local hemodynamic disturbances that promote thrombus formation and account for the high rate of recurrent distal embolism reported with medical therapy alone. Accurate diagnosis relies on careful evaluation with computed tomography angiography and multiplanar reconstructions, as CaW may be overlooked on conventional imaging. Current evidence indicates that, in symptomatic patients, antithrombotic therapy alone is insufficient to prevent early recurrence, whereas carotid revascularization with endarterectomy or stenting provides excellent safety and efficacy. In contrast, optimal management of asymptomatic CaW remains uncertain and is generally based on clinical and imaging surveillance. This review summarizes the diagnostic features, natural history, and treatment strategies of CaW and presents a practical algorithm to support clinical decision-making in neurovascular practice.