Abstract Details

Title Carotid Web Stenting After Mechanical Thrombectomy: How Long Should We Wait? A Case Report and Review of Literature

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (5:30 PM-6:30 PM)

Poster/Presentation
Number 5-023

Objective In this study, we present a case of carotid artery stenting following endovascular thrombectomy (EVT) on a patient with symptomatic carotid web.

Background A carotid web is an intraluminal shelf-like projection that arises from the carotid bifurcation and is increasingly recognized as a cause of recurrent ischemic stroke. Carotid artery stenting has recently emerged as a viable treatment option; however, the optimal timing for intervention following acute ischemic stroke remains controversial in the literature.

Design/Methods NA

Results A 43-year-old male with no medical history presented with sudden onset left-sided weakness, numbness, and dysarthria, last known normal reported 4 hours prior to presentation. Initial National Institute of Health Stroke Scale (NIHSS) score was 10. CTH revealed a chronic appearing right MCA infarct involving M4 and M5 segments, but no evidence of acute ischemia or hemorrhage. Thrombolysis with alteplase was administered. CTA showed a right MCA occlusion at M1 segment, and CTP showed an 8mL core and 155 mL penumbra. The patient underwent EVT with a TICI 2b reperfusion. Digital subtraction angiogram (DSA) revealed evidence of a right proximal ICA carotid web, and further investigation did not reveal any other stroke etiology. Seven days post-stroke, the patient underwent successful placement of a 10 - 8 mm X 40 mm Xact carotid stent with no complications. The patient was discharged with a NIHSS score of 1 and DAPT.

Conclusions Treatment options for symptomatic carotid web include interventional therapy with carotid stenting or endarterectomy versus medical therapy. Previous studies have shown a high risk of recurrent stroke despite maximal medical management. In this study, we present a young patient with no traditional stroke risk factors who underwent successful stenting seven days after stroke. Considering the elevated risk of stroke recurrence, early stenting could be a safe and feasible option for secondary stroke prevention in patients with carotid web.

Authors/Disclosures
Noelia C. Morales, MD PRESENTER	Dr. Morales has nothing to disclose.
Cesar E. Escamilla-Ocanas, MD	Dr. Escamilla-Ocanas has nothing to disclose.
Omar Tanweer	No disclosure on file
Ravi Shastri (Baylor College of Medicine)	Ravi Shastri has nothing to disclose.

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