Carotid Webs: An Unusual Presentation of Fibromuscular Dysplasia

Carotid webs are abnormal luminal projections at the carotid bulb associated with blood flow stasis, artery dissection, and subsequent complications. Carotid webs are considered to be a rare variant of fibromuscular dysplasia (FMD). Young individuals with symptomatic carotid webs are found to be associated with ischemic stroke. The incidence of the carotid web is low, and it is rarely reported. Only 150 cases of FMD have been reported so far. FMD is a non-inflammatory and non-atherosclerotic arteriopathy. The most common arterial beds involved are renal and extracranial carotids. Presentation varies depending on the location of the arterial bed involved and disease severity. Clinical presentations range from minor headaches to severe headaches, resistant hypertension, acute coronary syndrome, transient ischemic attack, and in some cases, stroke. Diagnosis can be made through non-invasive methods, such as computed tomographic angiography, magnetic resonance angiography, or duplex ultrasonography or invasive imaging methods like catheter-based angiography. Treatment of FMD varies with disease presentation and its location. Asymptomatic carotid or vertebral arteries FMD should be monitored clinically and prescribed aspirin 81 mg daily for primary stroke prevention. Endovascular and surgical therapy with stents or coils is reserved for patients with aneurysms. We present a rare and interesting case of a 54-year-old female who presented with acute ischemic stroke in the setting of right carotid artery web, right internal carotid artery (ICA) thrombus with dissection, and possible pseudoaneurysm.