Assessment of Recurrent Stroke Risk in Patients With a Carotid Web

Guglielmi, Valeria; Compagne, Kars C.J.; Sarrami, Amir Hossein; Sluis, Wouter M; Berg, Lucie A. van den; Sluijs, P Matthijs van der; Mandell, Daniel M.; Lugt, Aad van der; Roos, Yvo B.W.E.M.; Majoie, Charles B. L. M.; Dippel, Diederik W.J.; Emmer, Bart J.; Es, Adriaan C G M van; Coutinho, Jonathan M.; trial, Clean; Investigators, Clean Registry

doi:10.1001/jamaneurol.2021.1101

Cited by 47 publications

(29 citation statements)

References 28 publications

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“…However, there was no statistical difference in hematological indexes between the two groups. In this study, the proportion of male CaW patients was higher than that of female CaW patients, which contradicted the previous conclusion that there were more female patients than male patients ( 26 , 27 ). This may be due to selection bias in the preponderance of male patients.…”

Section: Discussioncontrasting

confidence: 99%

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The Value of Contrast-Enhanced Ultrasound in the Evaluation of Carotid Web

Zhou

Feng

et al. 2022

Front. Neurol.

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ObjectivesThe purpose of this study was to investigate whether contrast-enhanced ultrasound (CEUS) is more advantageous than conventional ultrasound in the diagnosis of carotid web (CaW) and to compare the clinical characteristics of patients in different age groups.MethodsSeventeen patients admitted to the hospital from October 2019 to December 2021 were included in our study. Patients were initially diagnosed with CaW using digital subtraction angiography (DSA), and conventional ultrasound and CEUS were completed. Baseline patient data were analyzed and compared between the <60 years old CaW group and the ≥60 years old CaW group to explore the differences between the two groups. Then, comparing the accuracy of conventional ultrasound and CEUS.ResultsA total of 17 CaW patients participated in this study, including 4 female patients (23.5%) and 13 male patients (76.5%), with an average age of 59.41 (±10.86) years. There were 9 patients (52.9%) with left CaW and 8 patients (47.1%) with right CaW. Acute ischemic stroke (AIS) occurred in 14 patients (82.4%). Thrombosis occurred in five of 17 patients (29.4%). There was a significant statistical difference about the thrombosis between the <60 years old CaW group and the ≥60 years old CaW group [<60 years group: 0 (0%), ≥60 years group: 5 (62.5%), P = 0.005]. Seven patients (41.2%) received medical management, nine patients (52.9%) had carotid artery stenting (CAS), and one patient (5.9%) had carotid endarterectomy (CEA). None of the patients had recurrent stroke during the follow-up period. The diagnostic rate of CaW and thrombus by CEUS was higher than that by conventional ultrasound, and there was a significant statistical difference in the diagnosis of thrombus between CEUS and conventional ultrasound (χ2 = 4.286, P = 0.038).ConclusionsCEUS may have a higher diagnostic accuracy for CaW with thrombosis, and it has a higher clinical application prospect.

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Section: Discussioncontrasting

confidence: 99%

“…Most of these patients were treated with antiplatelet therapy. However, the incidence of recurrent stroke was relatively higher in patients receiving anticoagulant therapy ( 27 ). Therefore, antiplatelet therapy is a reasonable treatment strategy in the patients with transient ischemic stroke or minor stroke ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

The Value of Contrast-Enhanced Ultrasound in the Evaluation of Carotid Web

Zhou

Feng

et al. 2022

Front. Neurol.

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“…A matched case-control study showed 23% ipsilateral CaW in anterior carotid cryptogenic strokes versus none on trauma control cases 10. Patients with symptomatic CaW have been demonstrated to have pronounced rates of recurrent ischemic events, ranging from 17% to 71% and commonly occurring despite the use of antithrombotics 1 3 5 8 11…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis between 1-D, 2-D and 3-D carotid web quantification

Câmara

Nogueira

Pisani

et al. 2022

J NeuroIntervent Surg

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BackgroundCarotid webs (CaW) are now recognized as a cause of ischemic stroke in young patients. The thromboembolic potential appears related to the CaW’s morphology and consequent impact on local flow dynamics. We aim to evaluate the reliability of different measurement methods for the quantification of CaW and their relationship to symptomatic status, presence of large vessel occlusion stroke (LVOS), clot burden and final infarct volume.MethodsThis was a retrospective analysis of the local comprehensive stroke center CaW database (September 2014–July 2019). CT angiograms (CTAs) were reviewed independently by two raters, blinded to the clinical information and laterality of the stroke/transient ischemic attack. CaW were quantified with 1-D (length), 2-D (area) and 3-D (volume) measurements via Osirix software. Final infarct volume was calculated on MRI. Patients with superimposed CaW thrombus and no repeat imaging were excluded.ResultsForty-eight CaW (37 symptomatic and 11 contralateral/asymptomatic) in 38 patients were included. Mean age (±SD) was 48.7 (±8.5) years, 78.9% were women and 77.1% were black. Inter-rater agreement was 0.921 (p<0.001) for 1-D, 0.930 (p<0.001) for 2-D, and 0.937 (p<0.001) for 3-D CaW measurements. When comparing symptomatic with asymptomatic CaW, mean web length was 3.2 mm versus 2.5 mm (p<0.02), median area was 5.8 versus 5.0 mm2 (p=0.35) and median volume was 15.0 versus 10.6 mm3 (p<0.04), respectively. CaW with a thinner profile (longer intraluminal projection compared with the base) were more likely to be symptomatic (0.67±0.17 vs 0.88±0.37; p=0.01). Average CaW 1-D and final infarct volume had a weak but positive association (Κ=0.230, p<0.05), while no association among web measurements and the presence of LVOS or clot burden was observed.ConclusionCaW dimension quantification (1-D, 2-D and 3-D) is highly reproducible. Linear and volumetric measurements were more strongly associated with symptoms. The impact of CaW size on the presence of LVOS, clot burden and final infarct volume is unclear.

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“…Baseline data of 3439 adult patients with anterior circulation large-vessel occlusion stroke who underwent endovascular treatment showed that 30 (0.9%) of them were complicated by ipsilateral symptomatic carotid web. 12 Semerano et al found that, in 1430 patients with large-vessel occlusion stroke treated by endovascular thrombectomy, 11 (0.7%) had a symptomatic carotid web. 13 All of them achieved successful angiographic reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3) after endovascular thrombectomy.…”

Section: Discussionmentioning

confidence: 99%

Embolectomy of acute embolic stroke associated with ipsilateral carotid web: a case report and literature review

et al. 2021

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A carotid web is a thin intraluminal protrusion located in the posterolateral wall of the carotid bulb, which might be a risk factor for cryptogenic stroke. The mechanism of ischemic stroke caused by carotid web is still unclear, but it might be related to hemodynamic changes distal to the web, resulting in flow forces and remote embolization of fibrin-based clots. The diagnosis of a carotid web mainly depends on carotid artery imaging examinations. The main therapeutic strategies include medical treatment with oral antiplatelet agents and anticoagulants, and operative treatment, such as carotid endarterectomy and carotid artery stenting. Few cases of acute large-vessel occlusion undergoing mechanical thrombectomy in the setting of carotid web as the etiology have been reported. We report here a case of a 37-year-old woman who underwent stent retriever embolectomy after acute ischemic stroke. Carotid artery imaging examinations, including digital subtraction angiography and magnetic resonance imaging, and pathology showed that a carotid web was located at the proximal right internal carotid artery. We also discuss the clinical pathophysiological and imaging features, and the treatment of carotid web as described in the currently available literature.

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Assessment of Recurrent Stroke Risk in Patients With a Carotid Web

Cited by 47 publications

References 28 publications

The Value of Contrast-Enhanced Ultrasound in the Evaluation of Carotid Web

The Value of Contrast-Enhanced Ultrasound in the Evaluation of Carotid Web

Comparative analysis between 1-D, 2-D and 3-D carotid web quantification

Embolectomy of acute embolic stroke associated with ipsilateral carotid web: a case report and literature review

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