Carotid Webs and Recurrent Ischemic Strokes in the Era of CT Angiography

Choi, Philip; Singh, Dr RR; Trivedi, Anurag; Qazi, Emmad; George, Daniel J.; Wong, Joseph M.; Demchuk, Andrew M.; Goyal, Mayank; Hill, Michael D.; Menon, Bijoy K

doi:10.3174/ajnr.a4431

“…The 1.0% prevalence of carotid webs in our control group is similar to the 1.2% prevalence of webs in a sample of consecutive patients who underwent CTA for suspected stroke at a single hospital. 3 This is not surprising because the latter sample was from a much less selected group of patients and likely included patients with stroke mimics, posterior circulation strokes, and a majority of noncryptogenic strokes.…”

Section: Cases and Controls Patients With Ischemic Stroke Of Undetermentioning

confidence: 99%

“…If thrombus formation in the relatively stagnant blood along the downstream surface of a web is analogous to thrombus formation in the left atrial appendage of the heart, perhaps anticoagulation is warranted. 3 Antiplatelet therapy, carotid angioplasty and stenting, and endarterectomy are other potential options. In the largest case series of carotid webs, after a mean follow-up of 2 years, the recurrent stroke rate was 0% (0 of 7 patients) in the surgical group compared with 30% (6 of 20 patients) in the antiplatelet therapy-only group.…”

Section: Cases and Controls Patients With Ischemic Stroke Of Undetermentioning

confidence: 99%

Carotid artery web and ischemic stroke

Coutinho

¹

,

Derkatch

²

,

Potvin

³

et al. 2017

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Objective: To determine whether there is an association between carotid artery web and ischemic stroke.Methods: This was a single-center, age-and sex-matched, case-control study. Cases were consecutive patients with anterior circulation ischemic stroke of undetermined etiology (Trial of Org 10172 in Acute Stroke Treatment [TOAST] classification). Controls were consecutive patients with cerebral aneurysms, arteriovenous malformations, or primary intracerebral hemorrhages. Additional inclusion criteria were age ,60 years and CT angiography of the neck. Two neuroradiologists diagnosed webs according to previously published criteria. One neuroradiologist also assessed for nonstenotic atherosclerotic plaque (carotid wall thickness $3 mm or intramural calcification). We used conditional logistic regression to estimate the odds ratio between carotid web and ischemic stroke and its 95% confidence interval.Results: Fifty-three of 62 cases (85%) were matched by age (within 1 year) and by sex to 102 controls. There was a carotid web in 4 of 53 cases (9.4%) vs 1 of 102 controls (1.0%, odds ratio 5 8.0, 95% confidence interval 5 1.2-67, p 5 0.032). There was no significant difference in the prevalence of nonstenotic carotid atherosclerotic plaque between the case and control groups. There was agreement on diagnosis of web for 163 of 164 patients (99%) and 7 of 8 webs (88%), and the Cohen k for interobserver agreement was 0.93. Conclusions:There is an association between carotid artery web and ischemic stroke in patients who lack an alternative cause of stroke. Carotid web may be an underappreciated risk factor for stroke. Therapeutic decision making for secondary stroke prevention relies on determining the cause of the initial transient ischemic attack or ischemic stroke. However, in one-third of cases, there is no apparent cause. 1A potentially underrecognized source of cerebral embolus is a carotid artery web. A carotid web is a thin, membrane-like shelf of tissue that extends from the wall of the carotid artery into the lumen, usually at the origin of the internal carotid artery. Carotid webs were first described 4 decades ago in a study of catheter angiograms at the Massachusetts General Hospital, 2 and subsequent case reports have added z50 cases to the literature. It is hypothesized that blood stasis along the downstream surface of a web may lead to thrombus formation and thromboembolic stroke.3 However, evidence of an association between carotid web and ischemic stroke has been only anecdotal.We conducted a case-control study to determine whether there is an association between carotid artery web and ischemic stroke.

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“…On sagittal reformatted images (Fig 1A), we noticed a thin intraluminal filling defect along the posterior wall of the carotid bulb, which appeared as a septum on axial images (Fig 2A). When we used the definition set forth by Choi et al, 1 our patient had findings consistent with a carotid web. No other abnormality was identified on her CTA.…”

mentioning

confidence: 99%

“…n their article entitled "Carotid Webs and Recurrent Ischemic Strokes in the Era of CT Angiography," Choi et al 1 described the prevalence, demographics, clinical presentation, imaging features, histopathology, and stroke risk associated with carotid webs. We read this thorough review with great interest, and it has already helped us in our clinical practice.…”

mentioning

confidence: 99%

Carotid Web: Appearance at MR Angiography

Lantos

¹

,

Chazen

²

,

Gupta

³

2015

AJNR Am J Neuroradiol

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“…It is hypothesized that blood stasis along the downstream surface of a web may lead to thrombus formation and thromboembolic stroke. 3 However, evidence of an association between carotid web and ischemic stroke has been only anecdotal.…”

mentioning

confidence: 99%

Carotid artery web and ischemic stroke: A case-control study

2017

Neurology

1

0

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Objective: To determine whether there is an association between carotid artery web and ischemic stroke.Methods: This was a single-center, age-and sex-matched, case-control study. Cases were consecutive patients with anterior circulation ischemic stroke of undetermined etiology (Trial of Org 10172 in Acute Stroke Treatment [TOAST] classification). Controls were consecutive patients with cerebral aneurysms, arteriovenous malformations, or primary intracerebral hemorrhages. Additional inclusion criteria were age ,60 years and CT angiography of the neck. Two neuroradiologists diagnosed webs according to previously published criteria. One neuroradiologist also assessed for nonstenotic atherosclerotic plaque (carotid wall thickness $3 mm or intramural calcification). We used conditional logistic regression to estimate the odds ratio between carotid web and ischemic stroke and its 95% confidence interval.Results: Fifty-three of 62 cases (85%) were matched by age (within 1 year) and by sex to 102 controls. There was a carotid web in 4 of 53 cases (9.4%) vs 1 of 102 controls (1.0%, odds ratio 5 8.0, 95% confidence interval 5 1.2-67, p 5 0.032). There was no significant difference in the prevalence of nonstenotic carotid atherosclerotic plaque between the case and control groups. There was agreement on diagnosis of web for 163 of 164 patients (99%) and 7 of 8 webs (88%), and the Cohen k for interobserver agreement was 0.93. Conclusions:There is an association between carotid artery web and ischemic stroke in patients who lack an alternative cause of stroke. Carotid web may be an underappreciated risk factor for stroke. Therapeutic decision making for secondary stroke prevention relies on determining the cause of the initial transient ischemic attack or ischemic stroke. However, in one-third of cases, there is no apparent cause. 1A potentially underrecognized source of cerebral embolus is a carotid artery web. A carotid web is a thin, membrane-like shelf of tissue that extends from the wall of the carotid artery into the lumen, usually at the origin of the internal carotid artery. Carotid webs were first described 4 decades ago in a study of catheter angiograms at the Massachusetts General Hospital, 2 and subsequent case reports have added z50 cases to the literature. It is hypothesized that blood stasis along the downstream surface of a web may lead to thrombus formation and thromboembolic stroke.3 However, evidence of an association between carotid web and ischemic stroke has been only anecdotal.We conducted a case-control study to determine whether there is an association between carotid artery web and ischemic stroke.

show abstract

Carotid Webs and Recurrent Ischemic Strokes in the Era of CT Angiography

Abstract: BACKGROUND AND PURPOSE:Carotid webs may cause recurrent ischemic stroke. We describe the prevalence, demographics, clinical presentation, imaging features, histopathology, and stroke risk associated with this under-recognized lesion.

Cited by 192 publications

References 16 publications

Carotid artery web and ischemic stroke

Carotid artery web and ischemic stroke

Carotid Web: Appearance at MR Angiography

Carotid artery web and ischemic stroke: A case-control study

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