Carotid webs: a review of diagnosis and management strategies in current literature

Introduction: Carotid webs (CaW) are non-atherosclerotic fibrous bands which present as shelf-like linear intraluminal filling defects at the carotid bulb or internal carotid artery. They are a known cause of cryptogenic strokes. Current management includes medical, interventional (stenting) and surgical approaches. Aims: The aim of this review was to systematically evaluate the existing evidence in the literature on the diagnosis, management and outcomes of carotid webs. Methods: This review was performed in accordance with the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A combination of the medical subject headings (MeSH) terms “carotid web”, “carotid shelf”, “CaW”, “web vessels”, “Intraluminal web” and “cryptogenic stroke”, “ischaemic stroke”, “embolic stroke of undetermined source” was utilised in the primary search. Basic descriptive statistical analysis was completed using IBM’s Statistical Package for the Social Sciences (SPSS) statistics software, version 29. Results: 123 articles met the criteria and underwent data extraction. This included two registry reviews, 13 cohort studies, 20 case series and 73 case reports. The articles spanned from 1967 to 2024. A pooled total of 771 patients were included (registry and cohort studies n=559; case series/case reports n=212). A higher prevalence of CaW is reported in young female patients and in patients of Afro-Caribbean origin. Symptom recurrence is reduced following intervention in the form of stenting or open surgery in a subset of patients. There is little evidence on the management of asymptomatic CaW. Conclusions: Current literature on CaW lacks homogeneity and is mostly anecdotal in nature. Previous studies have focused on diagnosis, with emerging cohort studies in the last decade evaluating management options. Further large-scale studies are needed. Establishing a worldwide registry will allow standardisation of the data collected and evaluated. Improving the quality of evidence available will help to guide management.