Prevalence of Carotid Web in Patients with Acute Intracranial Stroke Due to Intracranial Large Vessel Occlusion

Abstract

Purpose To investigate the prevalence of symptomatic carotid web in patients with acute ischemic stroke due to intracranial large vessel occlusion, to determine the clinical and imaging profile of patients with carotid web as well as their association with ischemic stroke, and to determine the interobserver agreement in the assessment of carotid webs. Materials and Methods All patients (n = 500) of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) in whom the carotid bifurcation could be assessed (n = 443) were included. The presence of a carotid web at the carotid bifurcations was evaluated at computed tomographic (CT) angiography. Demographics, clinical characteristics, and imaging baseline characteristics were presented by descriptive statistics for patients with an identified carotid web. Interobserver agreement in the detection of carotid webs was examined by using kappa statistics. Results Eleven (2.5%) carotid webs were found at the symptomatic side and two (0.5%) carotid webs were found at the asymptomatic side. Ten (91%) patients with a symptomatic carotid web were female. Nine patients with a symptomatic carotid web did not have major risk factors or other causes for ischemic stroke (82%). Fair to good interobserver agreement (κ, 0.72) was observed for diagnosing carotid webs at CT angiography. Conclusion Carotid webs at the symptomatic carotid bifurcation were observed in 2.5% of the patients with acute ischemic stroke due to large vessel occlusion and were mostly diagnosed in female patients with a fair to good interobserver agreement. RSNA, 2017 Clinical trial registration nos. NTR1804 and ISRCTN10888758 Online supplemental material is available for this article.

Financial relationships between neurologists and industry: The 2015 Open Payments database

“…HR-MRI enables visualization of the webs that are small, thin, membranous, filamentous, or diaphragm-like 3,4. A recent large acute stroke trial reported carotid web on the symptomatic side in 2.5% of patients 5. In an ongoing prospective study of HR-MRI in patients with >50% symptomatic carotid stenosis, we observed carotid webs of various morphologies in about 22%.…”

Cryptogenic Stroke Caused by a Carotid Web with a Superimposed Thrombosis: Serial Neurosonologic Findings

“…Herein, we describe a case of acute ischemic stroke due to right MCA occlusion with an ipsilateral carotid web. From a clinical perspective, the following important points in our case deserve discussion: 1) a carotid web without any evidence of cardioembolism or large artery atherosclerosis could be the sole source of brain embolism, which necessitates endovascular mechanical thrombectomy; 4 2) a carotid web after acute ischemic stroke could be a source of recurrent embolism with reemergence of newly formed thrombus around the web, especially in cases not treated with antithrombotics during the acute phase of stroke because of the risk of hemorrhage; and 3) serial follow-up neurosonologic examinations, which are simple and readily accessible, could be an important diagnostic tool for decision making on the timing of antithrombotic use because a carotid web has an early dynamic course from innocent web to superimposed thrombosis.…”

“…2 In the subanalysis of the multicenter randomized trial of endovascular treatment for acute ischemic stroke in the Netherlands (MR CLEAN) trial, the incidence of carotid web was 2.5% ipsilateral to index stroke. 4 However, the serial imaging depiction of the carotid web was not well reported because of its rarity in clinical practice and the limited availability of repeated imaging acquisition. Herein, we report serial imaging findings of carotid web, using ultrasonography, which is the simplest and easily accessible imaging modality, to depict the natural course of the superimposed thrombosis in the carotid web with anticoagulant therapy.…”

Clinical Reasoning: Transient speech deficits in a patient with history of medulloblastoma

“…3,4 A recent large acute stroke trial reported carotid web on the symptomatic side in 2.5% of patients. 5 In an ongoing prospective study of HR-MRI in patients with >50% symptomatic carotid stenosis, we observed carotid webs of various morphologies in about 22%. Various protocols may help with in-depth evaluation of carotid web morphology, composition, as well as associated hemodynamic alterations.…”