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

Abstract

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.

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

“…In addition, fourteen patients (82.4%) experienced AIS. There was no significant difference when looking at the prevalence of the left CaW group and the right CaW group, which is consistent with previous study ( 25 ). Moreover, our results showed that there were statistical differences in the thrombosis between the <60 years old CaW group and the ≥60 years old CaW group ( P = 0.005).…”

“…However, whether any of these treatment strategies are optimal remains unclear. 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 ).…”

“…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 ).…”

Multimodality imaging of carotid web: A case report and literature review

“…[1][2][3] Several studies suggest that patients with symptomatic CW have a high risk of recurrent stroke, even if they receive medical treatment. [4][5][6] Carotid revascularization may be safe and effective in patients with CW. 6,7 However, many clinicians have insufficient understanding of CW.…”

“…[4][5][6] Carotid revascularization may be safe and effective in patients with CW. 6,7 However, many clinicians have insufficient understanding of CW. It is easy for it to escape diagnosis or be misdiagnosed, since it rarely causes hemodynamic stenosis.…”