Carotid webs management in symptomatic patients

Multon, Sébastien; Denier, Christian; Charbonneau, Phillippe; Sarov, Mariana; Boulate, David; Mitilian, Délphine; Mougin, Justine; Chassin, Olivier; Legris, Nicolas; Fadel, Élie; Haulon, Stéphan; Fabre, Dominique

doi:10.1016/j.jvs.2020.08.035

Cited by 20 publications

(11 citation statements)

References 22 publications

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“…Surgery has been proposed as invasive treatment option, 3 and small series of carotid endarterectomy in symptomatic CaW have reported data for acceptable safety and efficacy after a median follow-up around 12 months. 3,13,[24][25][26] Endovascular procedure has also been reported as safe, 27 and a recent study 28 showed that the procedure performed in 24 symptomatic CaW patients was effective to prevent recurrence after a median clinical follow-up of 12 months. Although no randomized data are available, invasive treatment such as surgery or stenting seems now increasingly proposed as secondary preventive strategy.…”

Section: Discussionmentioning

confidence: 99%

Stroke Recurrence in First-Ever Symptomatic Carotid Web: A Cohort Study

et al. 2021

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Background and Purpose Carotid web (CaW) is an intimal variant of fibromuscular dysplasia responsible for ipsilateral cerebral ischemic events (CIE). Symptomatic CaW likely has a high risk of recurrent CIE, but no salient prospective data are available. We aimed to assess recurrence rate and its predictors after a first-ever CIE.Methods Consecutive Afro-Caribbean patients who had cryptogenic first-ever CIEs (ischemic stroke [IS] or transient ischemic attack [TIA]) associated with ipsilateral CaW were included in this multicenter observational cohort study. The follow-up (January 2008 to March 2019) focused on CIE recurrences. Kaplan-Meier method assessed rates of recurrences and Cox proportional hazards regression analyzed risk factors.Results Ninety-two patients (79 first-ever ISs and 13 TIAs; mean age±standard deviation, 49.8±9.9 years; 52 [56.5%] women) were included. During a mean follow-up of 50.5±29.6 months, 19 (20.7%) patients experienced recurrent ipsilateral CIEs (16 ISs and three TIAs). Of 23 patients receiving surgery/stenting treatment, no recurrence occurred after the intervention (median follow-up, 39.8 months [interquartile range, 27.6 to 72.4]). Under medical treatment alone, the annual recurrent CIE rate was 6.9%, and the cumulative rate was 4.4% at 30-day, 10.8% at 1-year, 19.8% at 2-year, 23.2% at 3-year, and 27.3% at 5-year. Presence of silent cerebral infarctions was the only independent risk factor of CIE recurrences (hazard ratio, 6.99; 95% confidence interval, 2.4 to 20.4; <i>P</i>=0.004).Conclusions Under medical treatment alone, symptomatic CaW was associated with a high rate of recurrence that reached 27.3% at 5-year. Surgery/stenting seems to be efficient, and randomized control trials are required to confirm the benefit of these interventions.

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Section: Discussionmentioning

confidence: 99%

Stroke Recurrence in First-Ever Symptomatic Carotid Web: A Cohort Study

et al. 2021

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“…Medical management alone has a higher recurrence rate ( 25 ). Although surgery is a first-line treatment strategy, patients may be at risk of vascular occlusion and more severe carotid stenosis ( 25 , 42 ). CAS is the preferred treatment strategy because of its safety and effectiveness ( 43 ).…”

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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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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“…The follow-up at 30 days and 1 year was uneventful for all patients, without any deaths or stroke recurrences. 13 In one of the largest case series, Haussen et al, have reported data on carotid stent for webs showing effective strategy for secondary prevention with no periprocedural complications. After a 12-month follow-up of sixteen patients who underwent stenting, there were no recurrent strokes or TIA and no detectable carotid restenosis.…”

Section: Discussionmentioning

confidence: 99%

Delayed Thrombus on Carotid Web: Case Report With Escalation of Treatment

Kodankandath

2021

The Neurohospitalist

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Carotid artery web is an underrecognized source and is found in about 1-2% of patients with acute ischemic stroke. Although, first described four decades ago, optimal therapy for carotid web is not yet known. Carotid stenting and endarterectomy are increasingly used for carotid web treatment, given its definitive treatment and avoiding the complications associated with anticoagulation. The case reported here is of an ischemic stroke secondary to a mobile thrombus on a carotid web evident on CT angiography and successful definitive treatment with delayed carotid wall stent placement. In young patients who have a diagnosis of ischemic stroke, the carotid web should be on the differential and adequate neuroimaging with either CTA or DSA should be pursued.

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Carotid webs management in symptomatic patients

Cited by 20 publications

References 22 publications

Stroke Recurrence in First-Ever Symptomatic Carotid Web: A Cohort Study

Stroke Recurrence in First-Ever Symptomatic Carotid Web: A Cohort Study

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

Delayed Thrombus on Carotid Web: Case Report With Escalation of Treatment

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