How do you manage asymptomatic patients with incidental findings of the carotid web?

Terrific question. I would certainly not pursue interventional treatment in asymptomatic patients with carotid web. The role of aspirin is also debatable and not conclusively proven. I would ensure vascular risk factors are controlled and consider starting aspirin if otherwise indicated based on overall cardiovascular risk. However, the role of high-resolution carotid MRI or transcranial Doppler with microembolic detection to risk-stratify patients with carotid web is not well established.

I do nothing unless it is symptomatic on that side.