Carotid web and ischemic stroke: a CT angiography study

Yu, Yang; Wang, Baozhen; Zheng, Shugang; Kou, Jieli; Gu, Xiaofei; Liu, Taotao

doi:10.1016/j.clinimag.2020.05.033

Cited by 12 publications

(12 citation statements)

References 27 publications

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“…This result is in the line with other studies of Mei et al, which reported the prevalence of CaW of 1.6% in US cohort of patients with ischemic stroke (IS) [ 15 ] and 2.2% in Asian cohort with IS [ 16 ]. However, our final study group, which consisted of the patients who met the rigorous inclusion criteria, was much numerous (14.9%).…”

Section: Discussionsupporting

confidence: 93%

Fibromuscular Dysplasia/Carotid Web in Angio-CT Imaging: A Rare Cause of Ischemic Stroke

et al. 2021

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Background and Objectives: Carotid web (CaW) is an intimal variant of fibromuscular dysplasia and may constitute as one of rare causes of acute ischemic stroke (AIS). The objective of this study was to determine the prevalence of CaW in patients with AIS or transient ischemic attack (TIA) based on head/neck CT angiography (CTA) in a Polish cohort study. Materials and Methods: A retrospective study was performed by analyzing 1480 electronic clinical and imaging data regarding patients with AIS or TIA, hospitalized in the years 2018–2020 in the authors’ institution. The final sample consisted of 181 patients who underwent head/neck CTA; aged 67.81 ± 13.51 years (52% were women). All head/neck CTA studies were independently evaluated by two radiologists. The patient’s clinical condition was assessed with the National Institutes of Health Stroke Scale (NIHSS, 5.76 ± 4.05 and 2.88 ± 3.38 at admission and at discharge, respectively). Results: 27 patients were identified with CaW. The prevalence of CaW in the final sample (181 pts with good quality CTA) was 14.9%. In the CaW group, 89% patients had AIS, including 26% diagnosed with recurrent and 11% with cryptogenic strokes. There were no significant differences between the presence of CaW and gender, age, NIHSS score, recurrent or cryptogenic stroke. Conclusions: Our study demonstrated that CaW may be an underrecognized entity leading to cerebrovascular events. The diagnosis of CaW depends on a high level of awareness and a comprehensive analysis of the neuroimaging studies. Our findings support the hypothesis that it is worthwhile to perform CTA to determine the etiology of ischemic stroke, particularly if predicting factors were not identified.

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Section: Discussionsupporting

confidence: 93%

Fibromuscular Dysplasia/Carotid Web in Angio-CT Imaging: A Rare Cause of Ischemic Stroke

et al. 2021

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“…A recent study carried out by Yu et al, which retrospectively evaluated 1662 stroke patients, found that 285 of these patients were diagnosed with cryptogenic stroke and 33 patients had neck images compatible with the carotid web [4]. Although the prevalence in this study for the carotid web was 2.2% (95% confidence interval = 0.015-0.030), what is impressive is that the median age was 44 years (interquartile range = 38-53).…”

contrasting

confidence: 55%

“…More than 60% of the cases occurred in women. Furthermore, in 78.8% of the cases, the stroke was ipsilateral to the carotid web finding [4]. In the study by Haussen et al, the median age of the patients with the carotid web was 46 (interquartile range = 41-59), more than 60% were women, and other risk factors for stroke such as hyperlipidemia were present in only 4% of the subjects, with a median low-density lipoprotein of 89 (interquartile range = 77-130) mg/dl and a median hemoglobin A1c of 5.5% [5].…”

mentioning

confidence: 92%

Cryptogenic stroke: Much and nothing at the same time

Picón-Jaimes¹,

Lozada-Martínez

Janjua

et al. 2021

Euro J of Neurology

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“…In addition to the present study, 9 studies [6,[8][9][10][11][12][13][14][15] were identified with a combined total of 3,192patients of whom 1,127 patients had cryptogenic stroke. We identified 4 studies [8][9][10]12] in which we could derive…”

Section: Systematic Review and Meta-analysismentioning

confidence: 97%

Ipsilateral internal carotid artery web and acute ischemic stroke: A cohort study, systematic review and meta-analysis

et al. 2021

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Introduction The carotid web is a compelling potential mechanism of embolic ischemic stroke. In this study, we aim to determine the prevalence of ipsilateral carotid web in a cohort of ischemic stroke patients and to perform a systematic review and meta-analysis of similar cohorts. Patients & methods We performed a retrospective, observational, cohort study of acute ischemic stroke patients admitted to a comprehensive stroke center from June 2012 to September 2017. Carotid web was defined on computed tomography angiography (CTA) as a thin shelf of non-calcified tissue immediately distal to the carotid bifurcation. We described the prevalence of carotid artery webs in our cohort, then performed a systematic review and meta-analysis of similar cohorts in the published literature. Results We identified 1,435 potentially eligible patients of whom 879 met criteria for inclusion in our analysis. An ipsilateral carotid web was detected in 4 out of 879 (0.45%) patients, of which 4/4 (1.6%) were in 244 patients with cryptogenic stroke and 3/4 were in 66 (4.5%) patients <60 years old with cryptogenic stroke. Our systematic review yielded 3,192 patients. On meta-analysis, the pooled prevalence of ipsilateral carotid web in cryptogenic stroke patients <60 was 13% (95% CI: 7%-22%; I2 = 66.1%). The relative risk (RR) of ipsilateral versus contralateral carotid web in all patients was 2.5 (95% CI 1.5–4.2, p = 0.0009) whereas in patients less than 60 with cryptogenic stroke it was 3.0 (95% CI 1.6–5.8, p = 0.0011). Discussion Carotid webs are more common in young patients with cryptogenic stroke than in other stroke subtypes. Future studies concerning the diagnosis and secondary prevention of stroke associated with carotid web should focus on this population.

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Carotid web and ischemic stroke: a CT angiography study

Cited by 12 publications

References 27 publications

Fibromuscular Dysplasia/Carotid Web in Angio-CT Imaging: A Rare Cause of Ischemic Stroke

Fibromuscular Dysplasia/Carotid Web in Angio-CT Imaging: A Rare Cause of Ischemic Stroke

Cryptogenic stroke: Much and nothing at the same time

Ipsilateral internal carotid artery web and acute ischemic stroke: A cohort study, systematic review and meta-analysis

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