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

Abstract

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.

The differences between carotid web and carotid web with plaque: based on multimodal ultrasonic and clinical characteristics

“…Consistent with previous studies [ 14 , 18 , 21 , 22 ], our results indicated that gender and age differences in the two groups were statistically significant. In the CW group, 57.4% of the participants were women with an average age of 50.61 (± 12.49) years.…”

“…The CTA/HRMRI imaging scanning protocols were the same as in the prior study [ 18 ], and the details of protocols are available in Supplementary 1 . All CTA and HRMRI images were reviewed by two experienced radiologists (W.Z.…”

The carotid web: Current research status and imaging features

“…CTA is relatively inexpensive, easy to perform, and safe compared to magnetic resonance angiography (MRA) and DSA. During a study performed to clarify the relationship between the carotid web and ischemic stroke, the length, area, and volume of the carotid web were measured using CTA images of both symptomatic and asymptomatic cases ( Perry da Camara et al, 2022 ), resulting in the following observations among symptomatic and asymptomatic cases, respectively: mean carotid web lengths of 3.2 and 2.5 mm; median areas of 5.8 and 5.0 mm 2 ; and median volumes of 15.0 and 10.6 mm 3 . Additionally, that study noted that patients with a thinner carotid web (the longer intraluminal projection compared with the base) were more likely to have symptoms.…”

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

“…and the presence of a contralateral asymptomatic CaW was stated. As previously described, 21 linear length of CaW was also calculated and expressed in millimeters (mm). Stenosis resulting from CaW was measured according to the European Carotid Surgery Trial (ECST) method 22 and was expressed as a percentage.…”