title: Neurointerventional management of carotid webs associated with recurrent and acute cerebral ischemic syndromes.
abstract: BACKGROUND
  A carotid web can be defined as an endoluminal shelf-like projection often noted at the origin of the internal carotid artery (ICA) just beyond the bifurcation. Diagnosis of a carotid web as an underlying cause of recurrent ischemic stroke is infrequent and easily misdiagnosed as an atheromatous plaque. Surgery has traditionally been used to resect symptomatic lesions while there is no enough evidence supporting medical therapy as the sole management. To our knowledge there is only one report about carotid artery stenting (CAS) as a definite management of carotid web and no previous reports of acute large-vessel occlusions undergoing mechanical thrombectomy in the setting of carotid web as the etiology.
  
  
  METHODS
  We report two cases: The first presented with recurrent ischemic stroke in the same arterial territory and the other with an emergent left middle cerebral artery (MCA) occlusion that underwent endovascular mechanical thrombectomy in which initial computed tomographic angiograms (CTA) suggested carotid web etiologies. Following confirmation with digital subtraction angiography (DSA), both patients ultimately underwent endovascular carotid stenting instead of surgical resection for definitive carotid web treatment.
  
  
  CONCLUSIONS
  Carotid webs are a rare cause of ischemic stroke in young and middle-aged adults that can readily be identified by CTA. Endovascular management may include emergent mechanical thrombectomy for large-vessel thromboembolic complications, and for definitive treatment with carotid stenting across the carotid web as an alternative to surgical resection and medical management for secondary stroke prevention.
authors.affiliation: Department of Radiology, Mansoura University, Egypt Department of Radiology, Northwestern University Feinberg School of Medicine, USA mokadem83@yahoo.com.
authors.forename: A H
authors.initials: AH
authors.lastname: Elmokadem
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, USA Department of Neurology, Northwestern University Feinberg School of Medicine, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Ansari
authors.affiliation: Department of Neurology, Northwestern University Feinberg School of Medicine, USA.
authors.forename: R
authors.initials: R
authors.lastname: Sangha
authors.affiliation: Department of Neurology, Northwestern University Feinberg School of Medicine, USA.
authors.forename: S
authors.initials: S
authors.lastname: Prabhakaran
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA.
authors.forename: A
authors.initials: A
authors.lastname: Shaibani
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Hurley
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000209:etiology* / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000150:complications* / Q000628:therapy*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis; D020768:Middle Cerebral Artery; D012008:Recurrence; D015607:Stents
keywords: Carotid; recurrent; stent; stroke; web