Carotid web, defined at vascular imaging as a thin intraluminal filling defect usually located at the posterior wall of the internal carotid artery bulb [1], is a suspected cause of ischemic stroke. Since its first description in 1965 [2], various names have been used, among which carotid bulb diaphragm [3,4], web-like septum [5], pseudovalvular fold [6], spur [3], making its definition difficult as a clear entity. In 1973, an analysis of 140 cases of non-atherosclerotic stenosis and occlusion of the internal carotid identified 4 cases of “web-like tissue” in the lumen of the internal carotid artery, only based on the angiographic description: the authors first used the name “carotid web” [7].

Since the carotid web is a rare entity that has long only been the subject of case reports [6,[8], [9], [10]], its prevalence, natural history, and management are not established. More recently, cohorts and case-control studies have assessed the prevalence of carotid web in patients presenting with an ipsilateral stroke varying from 2.5% to 23% [4,11,12] and from 21% to 37% in cryptogenic stroke [4,13,14]. The patients are mostly young women, free of cardiovascular risk factors, of African-American ethnicity [4,11,15]. In patients with an untreated carotid web, the rate of stroke/transient ischemic attack recurrence ranges from 29% to 83% [11,15,16]. Several studies with a limited sample of patients have evaluated the safety and feasibility of endarterectomy or stenting in carotid web [15], [16], [17]. Neither revascularization strategy is currently recommended more than the other.

Histology of carotid web specimens described it as fibromuscular dysplasia, atypical fibromuscular dysplasia, or intimal hyperplasia, sometimes associated with thrombus fragments. Standard features of atherosclerosis were not observed [16], [17], [18]. Although a few studies focused on carotid web histological presentation, data correlating it to the radiological description are still lacking. Using a retrospective series from recently symptomatic carotid web, we aimed to review the histological analysis and detail their standard features.