Multimodality Imaging in Carotid Web

Madaelil, Thomas P; Grossberg, Jonathan A; Nogueira, Raul G; Anderson, Aaron; Barreira, Clara M; Frankel, Michael; Haussen, Diogo C

doi:10.3389/fneur.2019.00220

Cited by 55 publications

(47 citation statements)

References 21 publications

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“…CTA is now considered as the method of choice for CaW diagnosis. 6,16 Carotid artery bulb was analyzed in the axial, coronal and sagittal plane of CTA using a maximal intensity projection reconstruction (Supplementary Figure 1). CTA patterns consistent with CaW were: (1) A linear defect that usually splits the arterial lumen on axial plane.…”

Section: Case Ascertainment Of Carotid Webmentioning

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: Case Ascertainment Of Carotid Webmentioning

confidence: 99%

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

et al. 2021

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“…CTA and DSA showed comparable and superior performance as compared to color-coded duplex sonography. 13 Due to limited data, best therapy strategy in patients with a carotid web remains open. 2,3,5,[7][8][9] Conservative therapy has been proposed and suggested to be effective especially in asymptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

“…CTA and DSA showed comparable and superior performance as compared to color-coded duplex sonography. 13 …”

Section: Discussionmentioning

confidence: 99%

Symptomatic carotid web in a female patient

Krasteva

Diamantaras

Siller

et al. 2020

SAGE Open Medical Case Reports

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We describe a 47-year-old female patient with a carotid web and ischemic stroke. A carotid web is a membrane-like shelf of tissue, predominantly affecting the intimal layer of the arterial wall, usually extending from the posterolateral wall of the carotid artery into the lumen, typically at the origin of the internal carotid artery just beyond the bifurcation. It is considered to be an under-recognized etiology of ischemic stroke in young and middle-aged patients. Typically, these patients do not show any coexistent or only few vascular risk factors. Digital subtraction angiography, computer tomography angiography, magnetic resonance angiography, and color-coded duplex sonography are able to identify carotid webs. Therapy strategies include conservative therapy with intake of antiplatelet agents and anticoagulants, or carotid endarterectomy or carotid artery stenting. Optimal therapy strategy remains open. A considerable rate of recurrent cerebrovascular ischemic events has been reported in patients with a symptomatic carotid web and conservative therapy. More data are needed on prevalence, diagnosis, prognosis and therapy of patients with an asymptomatic or a symptomatic carotid web. Subject Codes: [13] Cerebrovascular Disease/Stroke, [44] Acute Cerebral Infarction, [193] Clinical Studies

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“…Пациенты с КС характеризуются высокой частотой рецидивов ИИ: 67% в течение 3 мес. [53] и 32% в течение 12 мес., несмотря на антитромботическую терапию, что свидетельствует о целесообразности хирургических методов вторичной профилактики (стентирование или каротидная эндартерэктомия) [54,55].…”

Section: каротидная сетьunclassified

Cryptogenic stroke. Part 1: Aorto-arterial embolism

2021

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The article discusses the concept of embolic stroke from an unspecified source and the role of aorto-arterial embolism in its development. Potential causes of embolic cryptogenic stroke such as aortic atheromatosis, non-stenotic atherosclerosis of the cervical arteries, carotid web and intracranial atherosclerosis are discussed in detail. The discussion of each cause covers epidemiology, pathogenesis, and current approaches to diagnosis and secondary prevention. The diagnostic search is presented in the form of an algorithm. To identify aorto-arterial sources of embolism and to determine their clinical significance, a comprehensive examination including CT angiography with targeted assessment of the aortic arch, transesophageal echocardiography, MRI of the arterial wall and transcranial Doppler is required. When mechanical thrombectomy is performed, histological examination of the thromboembolus is advisable. Given that atherosclerosis is usually systemic, the search for a possible cause of aorto-arterial embolism should be a diagnostic priority in patients with cryptogenic stroke and other arterial (coronary, lower extremity) lesions. With regard to secondary prevention of cryptogenic stroke in the presence of potential sources of aorto-arterial embolism, the principle ‘the more embologenic the source, the more aggressive the prevention’ applies. The arsenal of secondary prevention includes strategies such as strict control of vascular risk factors, achieving target blood pressure, short- and medium-term dual antiplatelet therapy, and intensive hypolipidemic therapy. Surgical prophylaxis is warranted for stroke against a carotid background, the efficacy of which in non-stenotic atherosclerosis requires early evaluation in randomised trials. Each potential cause of cryptogenic stroke considered is illustrated by a clinical example.

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Multimodality Imaging in Carotid Web

Cited by 55 publications

References 21 publications

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

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

Symptomatic carotid web in a female patient

Cryptogenic stroke. Part 1: Aorto-arterial embolism

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