How do you approaach ischemic stroke from suspected symptomatic ipsilateral carotid web with less than 50% stenosis?

I would need to know what the definition of "suspected symptomatic" means in this setting. Is this the patient's first ischemic event? Or have there been multiple ischemic episodes? Is the stroke pattern sub-cortical/lacunar-type from uncontrolled microvascular risk factors or cortical-appearing suggesting an underlying embolic mechanism? These are some important variables to consider before providing an answer on management.

If the carotid web is considered the culprit, it's not the degree of s...

In general, carotid webs behave very differently from atherosclerotic plaque. We have pretty good data for what to do for atherosclerotic plaque, but much less for carotid webs. However, we do know that carotid webs create a nidus for stasis of blood, which can lead to clot formation. Because of this, carotid webs do carry a high recurrent stroke risk, which is not solely dependent on the degree of stenosis. Thus, we typically treat even if stenosis is <50%. The data for >50% is really for ather...