Carotid Web (Intimal Fibromuscular Dysplasia) Has High Stroke Recurrence Risk and Is Amenable to Stenting

Haussen, Diogo C; Grossberg, Jonathan A; Bouslama, Mehdi; Pradilla, Gustavo; Belagaje, Samir; Bianchi, Nicolas; Allen, Jason W.; Frankel, Michael; Nogueira, Raul G

doi:10.1161/strokeaha.117.019020

Cited by 160 publications

(231 citation statements)

References 15 publications

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“…Meanwhile, patients who were treated with antiplatelet therapy had a stroke recurrence rate of 30% at 2 years. In a series of 24 patients with stroke or transient ischemic attack, Haussen et al [8] found a recurrence rate of 32%, with 16 patients undergoing stent placement across the web with no complications or recurrent ischemic events. Similarly, in a series of 5 patients with carotid webs and recurrent stroke on medical therapy, 4 patients who underwent endarterectomy were stroke free after 3–7 months of follow-up [1].…”

Section: Discussionmentioning

confidence: 99%

“…Four case series and case reports with a total of 21 patients have reported outcomes of carotid web stenting in patients with symptomatic lesions (Table 1) [4, 8-10]. The largest study to date included 16 patients [8].…”

Section: Discussionmentioning

confidence: 99%

“…The largest study to date included 16 patients [8]. All cases were technically successful and there were no complications, recurrences or in-stent stenosis during follow-up periods ranging from 6 months to 8.5 years [4, 9, 10].…”

Section: Discussionmentioning

confidence: 99%

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Carotid Stenting for Treatment of Symptomatic Carotid Webs: A Single-Center Case Series

2018

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Background and Purpose: Carotid webs are an increasingly recognized cause of acute ischemic stroke, particularly in younger adults. The optimal medical and surgical strategies for managing these lesions have not been well established. We report a single-center case series of carotid stenting for treatment of symptomatic carotid webs. Materials and Methods: Consecutive patients undergoing stent placement for treatment of symptomatic carotid webs were included. Carotid webs were defined as a thin intraluminal filling defect along the posterior wall of the carotid bulb just beyond the carotid bifurcation on CTA. Data were collected on demographic characteristics, antiplatelet management, clinical presentation, imaging findings, treatment characteristics, complications, and stroke recurrence rates. Descriptive statistics are reported. Results: A total of 4 patients were treated. Their mean age was 44 years (range 30–50). Three patients were female and 1 was male. All patients were symptomatic presenting with ipsilateral transient ischemic attacks or stroke. Patients were placed on dual antiplatelet therapy with ticagrelor and aspirin prior to the procedure. There were no ischemic or hemorrhagic complications. Three patients had postoperative bradycardia, 1 of whom required atropine immediately following stenting. No patients had recurrent ischemic events. Conclusions: Stent placement for treatment of carotid webs can be performed safely. Further studies are needed to confirm our findings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Carotid Stenting for Treatment of Symptomatic Carotid Webs: A Single-Center Case Series

2018

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“…Treatment with surgical excision has been performed with encouraging results [1,2]. Carotid artery stenting (CAS) for CaW has been rarely described [3][4][5][6]. We aim to report a multicenter experience of CAS in patients with symptomatic CaW, discuss technical features, and describe procedural and clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Multicenter Experience with Stenting for Symptomatic Carotid Web

Haussen¹,

Grossberg²,

Koch³

et al. 2018

Intervent Neurol

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Background: A carotid web (CaW) is a shelf-like lesion in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. CaW has been associated with recurrent strokes and conventionally treated with surgical excision. We report a multicenter experience of stenting in patients with symptomatic CaWs. Methods: Retrospective review of consecutive patients admitted to 5 comprehensive stroke centers who were identified to have a symptomatic CaW and treated with carotid stenting. A symptomatic CaW was defined by the presence of a shelf-like/linear, smooth filling defect in the posterior aspect of the carotid bulb diagnosed by neck CT angiography (CTA) and confirmed with conventional angiography in patients with negative stroke workup. Results: Twenty-four patients with stented symptomatic CaW were identified (stroke in 83% and transient ischemic attack in 17%). Their median age was 47 years (IQR 41–61), 14 (58%) were female, and were 17 (71%) black. The degree of stenosis by NASCET was 0% (range 0–11). All patients were placed on dual antiplatelets and stented at a median of 9 days (IQR 4–35) after the last event. Closed-cell stents were used in 18 (75%) of the cases. No periprocedural events occurred with the exception of 2 cases of asymptomatic hypotension/bradycardia. Clinical follow-up after stent placement occurred for a median of 12 months (IQR 3–19) with no new cerebrovascular events noted. Functional independence at 90 days was achieved in 22 (91%) patients. Follow-up vascular imaging (ultrasound n = 18/CTA n = 5) was performed at a median of 10 months (IQR 3–18) and revealed no stenosis. Conclusions: Stenting for symptomatic CaW appears to be a safe and effective alternative to surgical resection. Further studies are warranted.

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“…CW is thought to represent an intimal variant of fibromuscular dysplasia. 1,2 Although data are scarce, CW may be associated with increased stroke risk in young patients with cryptogenic anterior circulation infarction and with a high risk of stroke recurrence. 2 …”

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confidence: 99%

Teaching NeuroImages: Multimodality imaging of carotid web

et al. 2018

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Carotid Web (Intimal Fibromuscular Dysplasia) Has High Stroke Recurrence Risk and Is Amenable to Stenting

Abstract: Carotid web is associated with high recurrent stroke/TIA risk, despite antithrombotic use, and is amenable to carotid stenting.

Cited by 160 publications

References 15 publications

Carotid Stenting for Treatment of Symptomatic Carotid Webs: A Single-Center Case Series

Carotid Stenting for Treatment of Symptomatic Carotid Webs: A Single-Center Case Series

Multicenter Experience with Stenting for Symptomatic Carotid Web

Teaching NeuroImages: Multimodality imaging of carotid web

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