Long-Term Outcomes and Management of Atypical Carotid Web in Nonagenarian
Bibliographic record
Abstract
Internal carotid artery webs (ICAWs) have been described as noninflammatory, nonatherosclerotic shelf-like projections of intimal fibrous tissue which may be the culprit for embolic stroke of unknown origin. Carotid webs are an atypical form of intimal fibromuscular dysplasia (FMD) and internal carotid webs create areas of stagnation and recirculation distal to the web that favor thrombus formation and embolism. Symptomatic carotid webs are conventionally associated with young women presenting with few vascular risk factors and < 50% stenosis in the affected ICA. ICAWs are being described more and more in the vascular literature, but the management of this pathology remains unclear. We describe a rare case of a 90-year-old male who presented with a significantly sclerosed symptomatic right ICAW without evidence of comorbid atherosclerotic disease. The clinical management, intraoperative findings, and postoperative course are described herein. At the age of 90, this patient is the oldest case of symptomatic carotid web recorded in the literature. Successful management with a carotid endarterectomy is an appropriate strategy for treatment even in a nonagenarian. We would favor carotid endarterectomy over carotid artery stenting given the circumferential, fibrotic nature of these lesions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".