# Carotid web: a little-known etiology of recurrent stroke - case report

## TL;DR

This case report describes a rare condition called carotid web that can cause repeated strokes in young patients and highlights the challenges in its diagnosis.

## Contribution

The paper presents a clinical case of carotid web and emphasizes the need for better understanding and recognition of this condition.

## Key findings

- Carotid web was detected in a 58-year-old patient with recurrent strokes using Doppler and digital subtraction angiography.
- The condition can be misdiagnosed as arterial dissection or atherosclerotic plaque due to similar imaging appearances.
- Endarterectomy with a bovine pericardium patch was performed successfully without the use of a vascular shunt.

## Abstract

Carotid web is a rare and poorly understood condition associated with cryptogenic and recurrent acute ischemic stroke in young patients without atherosclerotic risk factors. We describe the case of a 58-year-old female patient with hypertension and dyslipidemia who had recurrent ischemic strokes for 5 years. Presence of carotid web was suggested by Doppler ultrasonography and confirmed by digital subtraction angiography. The patient underwent endarterectomy and, due to satisfactory internal carotid reflux, it was decided not to use a temporary vascular shunt. Endarterectomy and arteriorrhaphy with a bovine pericardium patch were performed. Although carotid web can be seen with imaging exams, detection can be challenging and it can mimic other conditions, such as arterial dissection, non-calcified atherosclerotic plaque, and intraluminal thrombus. The ease with which it can go unnoticed or misdiagnosed highlights the need to understand this disease.

A membrana carotídea (MC) é uma condição rara e pouco compreendida associada a acidente vascular isquêmico (AVCi) criptogênico e recorrente em pacientes jovens sem fatores de risco ateroscleróticos. Descrevemos o caso de uma paciente do sexo feminino, com 58 anos, hipertensa, dislipidêmica e com quadro de AVCis há 5 anos. A presença de MC foi sugerida pela ultrassonografia Doppler e confirmada pela angiografia por subtração digital. A paciente foi submetida a endarterectomia e, devido ao refluxo satisfatório da carótida interna, optou-se por não utilizar shunt vascular temporário. Procedeu-se com a endarterectomia e arteriorrafia com patch de pericárdio bovino. Embora a MC possa ser visualizada por meio de exames de imagem, sua detecção pode ser desafiadora, podendo mimetizar outras condições, como dissecção arterial, placa aterosclerótica não calcificada e trombo intraluminal. A facilidade com que a MC pode passar despercebida ou ser mal diagnosticada ressalta a necessidade da compreensão desta doença.