A carotid web with accumulation of myofibroblasts: a case report

Carotid webs are increasingly recognized as potential sources of ischemic stroke among young patients without conventional cardiovascular risk factors. However, its pathophysiological mechanism remains unclear. We report a case in which a carotid web was resected via carotid endarterectomy (CEA), allowing for histological analysis. In a 49-year-old male, stenosis of the left internal carotid artery occurred via magnetic resonance imaging for medical examination. Carotid ultrasonography revealed turbulent blood flow around a flap-like lesion, which was consistent with a carotid web. Because this hemodynamic disturbance may increase the risk of ischemic stroke, CEA was performed. Histopathological examination revealed intimal hyperplasia with the accumulation of myofibroblast-like cells. Our pathological findings revealed intimal thickening and fibrosis and proliferation of SMA-positive, desmin-negative myofibroblast-like cells, suggesting that the dysregulation of myofibroblasts may underlie the pathogenesis of carotid webs.