Carotid webs and ischemic stroke: Experiences in a comprehensive stroke center

Sajedi, Payam; Chelala, Lydia; Nunez-Gonalez, Joel; Cronin, Carolyn A.; Kittner, Steven J.; Zhuo, Jiachen; Yang, Zhaohui; Gandhi, Dheeraj; Raghavan, Prashant

doi:10.1016/j.neurad.2018.09.003

Cited by 23 publications

(21 citation statements)

References 13 publications

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“…8 Our specimen consisted entirely of fibrotic intima, so we were unable to comment on myxoid degeneration of smooth muscle or increased elastic fiber deposition observed in the smooth muscle wall of other published specimens. 16 Our specimen does, however, confirm the fibrous intimal proliferation, focal intraluminal projection of intima, and mural thrombus formation on one surface of the fibrous shelf seen in previous specimens.…”

Section: Discussionsupporting

confidence: 73%

“…Various studies have reported the prevalence of carotid webs in cryptogenic stroke for patients below 60 years of age. 4,16,20 One study reported an incidence as low as 9.4% in a general Canadian population, 21 whereas Joux et al. have reported an incidence as high as 37% in the initial study of Afro-Caribbean patients with cerebral ischemia symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Safety and feasibility of carotid revascularization in patients with cerebral embolic strokes associated with carotid webs and histopathology revisited

et al. 2020

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Introduction Carotid web is increasingly recognized as the cause of ischemic embolic strokes in younger patients. The best way to treat carotid web is debatable and carotid artery stenting (CAS) has been reported as a treatment for the carotid web in only a few case series. In this study we evaluate the safety and feasibility of CAS in symptomatic carotid webs and examined the histopathology of a carotid web. Materials and methods At our institution between 2017 and 2019, 10 consecutive patients with symptomatic carotid webs were treated. We retrospectively analyzed the data for patient demographics, clinical presentation, imaging, treatment methodology and follow up. Results All the patients had presented with ipsilateral embolic stroke. The mean age at presentation was 50 years (range 37–71) with seven female and three male patients. All patients underwent CAS except one patient who underwent carotid endarterectomy (CEA). In one stented patient, there was significant hypotension in the post-procedural period lasting a week. The patients were followed for a mean of 5.5 months (range one day-12 months). No recurrent stroke or transient ischemic attack (TIA) occurred. Surgical pathological studies confirmed fibromuscular dysplasia in one specimen. Conclusion In our experience CAS for carotid web is feasible and safe in patients presenting with ischemic embolic strokes.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Safety and feasibility of carotid revascularization in patients with cerebral embolic strokes associated with carotid webs and histopathology revisited

et al. 2020

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“…A high incidence of ischemic stroke has been reported in patients with carotid web, ranging from 52.6% to 85.2% (Pereira et al, 2018;Sajedi et al, 2019;Wang et al, 2020;Zhang et al, 2018). These…”

Section: Introductionmentioning

confidence: 98%

Carotid web prevalence in a large hospital‐based cohort and its association with ischemic stroke

et al. 2021

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“…17 However, in patients with cryptogenic stroke, CA-Webs were more frequently found, ranging in 9.4% to 37% of these patients. 7,12,[14][15][16]18,20 Case-control studies have shown that CA-Web is associated with an increased risk of ipsilateral carotid territory ischemic stroke. In a population-based case-control study of Afro-Caribbean population, CA-Web was associated with a 9-fold increased risk of carotid territory ischemic stroke after adjustment for other major vascular risk factors (adjusted odds ratio [OR], 9.45 [95% CI, 1.71-52.21]; p =0.009).…”

Section: Epidemiologymentioning

confidence: 99%

“…9 The second pathologically proven symptomatic CA-Web case was additionally reported in 1979, 10 and then the following case reports, case-control studies, and reviews have highlighted CA-Web as an under-recognized cause in young patients with cryptogenic ischemic stroke. 7,8,[11][12][13][14][15][16][17][18][19][20]…”

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confidence: 99%

Carotid Web: Under-Recognized Etiology for Ischemic Stroke

Park

Hong

2018

J Neurosonol Neuroimag

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Carotid web (CA-Web) is defined as a rare form of focal intimal fibromuscular dysplasia, which is protruded into the lumen and forms a membrane-like shelf in the posterior aspect of the internal carotid artery (ICA) bulb. It could lead to flow stagnation and thrombus formation in the proximal ICA, and has been increasingly recognized as a potential source of thromboembolism in young patients with recurrent cerebral ischemic events in the anterior circulation of an undetermined cause. In the general population, the prevalence of CA-Web is unknown and it is rarely found among stroke patients. However, CA-Webs are more frequent among young patients with cryptogenic ischemic stroke. Despite antiplatelet therapies, these patients appear to have a higher risk of recurrent ischemic stroke. As alternatives, anticoagulation, surgical resection, and carotid artery stenting are being considered, but largely based on anecdotal evidence.

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Carotid webs and ischemic stroke: Experiences in a comprehensive stroke center

Cited by 23 publications

References 13 publications

Safety and feasibility of carotid revascularization in patients with cerebral embolic strokes associated with carotid webs and histopathology revisited

Safety and feasibility of carotid revascularization in patients with cerebral embolic strokes associated with carotid webs and histopathology revisited

Carotid web prevalence in a large hospital‐based cohort and its association with ischemic stroke

Carotid Web: Under-Recognized Etiology for Ischemic Stroke

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