Clinical, imaging, and management features of symptomatic carotid web: Insight from CAROWEB registry

Abstract

Background: Although Carotid Web (CaW) is increasingly diagnosed as a cause of cryptogenic stroke, data are still limited to monocentric small sample cohort. To broaden knowledge on symptomatic carotid web (CaW), CAROWEB registry has been recently implemented. Aims: In a large cohort of symptomatic CaW patients, we described epidemiologic characteristics, admission clinical and imaging features, and the current management including the secondary preventive strategy choice made in comprehensive French Stroke Units. Methods: CAROWEB is an ongoing French observational multicenter registry enrolling consecutive CaW patients diagnosed after an ipsilateral ischemic stroke (IS) or transient ischemic attack (TIA). Submitted cases were validated by two experienced neurologist and neuroradiologist. Clinical, imaging and management features were collected for this study. Results: Between June, 2019 and December, 2021, 244 cases were submitted by 14 centers, 42 rejected and 202 included (IS, 91.6%; TIA, 7.9%; retinal infarction, 0.5%; mean age, 50.8±12.2 years; female, 62.9%; Caucasian, 47.5%; Afro-Caribbean, 20.3%). IS patients showed: median (IQR) admission NIHSS score, 8 (2-15); intracranial artery occlusion, 71.8%; ipsilateral chronic cerebral infarction (CCI), 16.3%; reperfusion treatment, 57.3%. CaW was not identified during the mechanical thrombectomy procedure in 30/85 (35.3%). Secondary prevention was invasive in 55.6% (stenting, n=80; surgery, n=30). In multivariable analysis, the invasive therapeutic option was associated with ipsilateral CCI (OR:4.24 [1.27-14.2], p=0.019) and inversely associated with risk factors (OR:0.47, [0.24-0.91], p=0.0255), and admission NIHSS score (OR:0.93, [0.89-0.97], p=0.0012). Conclusion: CaW must be considered in all ethnic groups included Caucasians. Secondary prevention is heterogeneous in large French Stroke Centers. Absence of risk factors, milder severity strokes and ipsilateral CCI were predictive variables of secondary invasive treatment. The high rate of invasive treatment suggest that medical treatment alone is deemed ineffective to avoid recurrence and emphasize the need of randomized trials. Data Access Statement: Anonymized database used for these analyses are available from the corresponding author upon reasonable written request.

Carotid webs: a review of pathophysiology, diagnostic findings, and treatment options

“…In a separate study, Haussen et al7 suggested that patients with bilateral CaWs with a stroke have less conspicuous CaWs on the asymptomatic side than on the symptomatic side, although only a minority of symptomatic CaWs were associated with thrombi. Finally, results from the CAROWEB Registry,17 a multicenter prospective observational study of CaWs conducted in France, suggested that in comparison with asymptomatic CaWs, symptomatic CaWs were associated with a higher percentage of vessel narrowing as measured by the European Carotid Surgery Trial (ESCT) criteria.…”