Carotid Web in Elderly Patient with Recurrent Ischemic Stroke: A Case Report

CASE REPORT
Adel Alzahrani, Faisal Alghamdi, Meshari Alzahrani, Jumanah Ardawi, Fatima Altalhi, Mahammad Bokhary, Mohammad Shebly

 
For citation: Alzahrani A, Alghamdi F, Alzahrani M, Ardawi J, Altalhi F, Bokhary M, Shebly M. Carotid Web in Elderly Patient with Recurrent Ischemic Stroke: A Case Report. International Journal of Biomedicine. 2026;16(2):270-273. doi:10.21103/Article16(2)_CR2
 
Originally published June 5, 2026

Abstract: 

Background: A carotid web is a focal, shelf-like fibroelastic intimal protrusion in the proximal internal carotid artery, regarded as a variant of intimal fibromuscular dysplasia. It disrupts normal laminar flow, creating areas of stasis that predispose to thrombus formation and distal embolization, and is increasingly recognised as a cause of cryptogenic ischemic stroke, particularly in young and middle-aged adults without conventional vascular risk factors.
Case Presentation: A 61-year-old male with multiple vascular risk factors and a history of right-sided ischemic stroke who presented with recurrent transient left-sided weakness. CT angiography was limited by motion artefact, preventing accurate assessment. Subsequent duplex ultrasound revealed a characteristic echogenic shelf-like projection at the posterior wall of the right carotid bulb consistent with a carotid web. In view of recurrent ischemic symptoms, the patient underwent successful carotid artery stenting with restoration of normal flow dynamics.
Conclusion: This case emphasises the importance of multimodality vascular imaging and heightened clinical suspicion for carotid web in patients presenting with recurrent embolic events and minimal atherosclerosis. Early recognition and definitive intervention are essential to prevent recurrent cerebrovascular episodes.

Keywords: 
carotid web • embolic stroke • carotid artery stenting • duplex ultrasound • CT angiography • fibromuscular dysplasia
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Received February 10, 2026.
Accepted March 30, 2026.
© 2026 The Author(s). International Journal of Biomedicine is published by IMRDC.
This is an open access article under the CC BY-NC-ND 4.0 license.