Survey of Current Management Practices for Carotid Webs

Abstract

Background: Carotid webs are thick, fibrous intimal bands that appear as intraluminal shelf-like defects at the carotid bifurcation on vascular imaging. These lesions are a potential underrecognized cause of cryptogenic ischemic stroke. Although the recognition of carotid webs has increased, no evidence-based treatment guidelines are available. We surveyed subspecialists across multiple neurologic disciplines to assess the state of current clinical practice.Methods: An 8-question multiple-choice style survey of neurologists and radiologists assessed familiarity with this disease entity, preferred imaging modalities, and management strategies for asymptomatic and symptomatic (producing stroke) carotid webs. Responses were collected through SurveyMonkey software via anonymous responses to a posted survey link on the Society of Neurointerventional Surgery website in addition to invitation emails sent to colleagues in corresponding fields.Results: Of the 74 total respondents, 64% identified as neurointerventionalists. Respondents identified computed tomography angiography as the most commonly used imaging modality to place carotid webs in the differential diagnosis (57% of respondents’ preference), while conventional digital subtraction angiogram was the preferred modality to confirm a web (54% of respondents’ preference). Respondents preferred single and dual antiplatelet therapy to manage asymptomatic and acute stroke-producing carotid webs, while invasive treatment was most commonly sought for webs producing recurrent strokes.Conclusion: Familiarity with carotid webs varied across subspecialties. We found some consensus among respondents on the imaging modality preferred to identify webs, on asymptomatic carotid web management, and on recurrently symptomatic (multiple strokes) carotid web management. Less consistency was seen regarding preferences for confirmatory imaging and management of acutely symptomatic (initial stroke) carotid webs.

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

“…Our study showed that the diagnosis of CaW was highly underestimated as we considered the causes of ischemic strokes. It corresponds to Wojcik’s reports, which clearly show that familiarity with this clinical problem varies significantly between different specializations; however, generally, the knowledge about this pathology is low [ 14 ].…”

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

“…Although no randomized data are available, invasive treatment such as surgery or stenting seems now increasingly proposed as secondary preventive strategy. 29 In the present study, patients treated with surgery or stenting had a higher rate of vessel occlusion and a more severe stenosis related to CaW than medically treated patients. Physicians and patients may have been more convinced that CaW was responsible for CIE when the lesion was more prominent and associated with artery occlusion.…”

Safety and feasibility of carotid revascularization in patients with cerebral embolic strokes associated with carotid webs and histopathology revisited

“…CTA is the most commonly used method to diagnose a carotid web because the image can be reconstructed in multiple planes, and the contrast image identifies any thrombus associated with the carotid web 17 (Figure 1). Additionally, CTA provides high spatial density resolution images to evaluate for underlying atherosclerotic plaques or cholesterol deposits.…”