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von Oiste GG, Sangwon KL, Chung C, Narayan V, Raz E, Shapiro M, Rutledge C, Nelson PK, Ishida K, Torres JL, Rostanski SK, Zhang C, Yaghi S, Riina H, Oermann EK, Nossek E. Use of Carotid Web Angioarchitecture for Stroke Risk Assessment. World Neurosurg 2024; 182:e245-e252. [PMID: 38006939 DOI: 10.1016/j.wneu.2023.11.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE To examine the usefulness of carotid web (CW), carotid bifurcation and their combined angioarchitectural measurements in assessing stroke risk. METHODS Anatomic data on the internal carotid artery (ICA), common carotid artery (CCA), and the CW were gathered as part of a retrospective study from symptomatic (stroke) and asymptomatic (nonstroke) patients with CW. We built a model of stroke risk using principal-component analysis, Firth regression trained with 5-fold cross-validation, and heuristic binary cutoffs based on the Minimal Description Length principle. RESULTS The study included 22 patients, with a mean age of 55.9 ± 12.8 years; 72.9% were female. Eleven patients experienced an ischemic stroke. The first 2 principal components distinguished between patients with stroke and patients without stroke. The model showed that ICA-pouch tip angle (P = 0.036), CCA-pouch tip angle (P = 0.036), ICA web-pouch angle (P = 0.036), and CCA web-pouch angle (P = 0.036) are the most important features associated with stroke risk. Conversely, CCA and ICA anatomy (diameter and angle) were not found to be risk factors. CONCLUSIONS This pilot study shows that using data from computed tomography angiography, carotid bifurcation, and CW angioarchitecture may be used to assess stroke risk, allowing physicians to tailor care for each patient according to risk stratification.
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Affiliation(s)
- Grace G von Oiste
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Karl L Sangwon
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA.
| | - Charlotte Chung
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Vinayak Narayan
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Eytan Raz
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Maksim Shapiro
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Caleb Rutledge
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Peter Kim Nelson
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Koto Ishida
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Jose L Torres
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Sara K Rostanski
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Cen Zhang
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Shadi Yaghi
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Howard Riina
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Eric K Oermann
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Erez Nossek
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
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Chen H, Colasurdo M, Costa M, Nossek E, Kan P. Carotid webs: a review of pathophysiology, diagnostic findings, and treatment options. J Neurointerv Surg 2024:jnis-2023-021243. [PMID: 38290814 DOI: 10.1136/jnis-2023-021243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
A carotid web (CaW) is an atypical form of fibromuscular dysplasia characterized by a fibrous, shelf-like intimal flap originating from the posterior wall of the internal carotid bulb projecting into the arterial lumen. CaWs disturb normal blood flow and create stasis between the intimal reflection and the carotid wall, thereby promoting thrombogenesis and increasing the risk of downstream embolic strokes. Observational data have suggested that CaWs are associated with strokes with otherwise unknown etiology, particularly in young patients without other stroke factors, and stroke recurrence rates of symptomatic CaWs have been reported to be as high as 20% over 2 years. Despite its clinical importance, there are currently no clear guidelines on the management of CaWs. In this narrative review, we discuss the epidemiology, pathogenesis, pathophysiology, diagnosis, and treatment options for this under-recognized entity.
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Affiliation(s)
- Huanwen Chen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Department of Neurology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Marco Colasurdo
- Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Matias Costa
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Erez Nossek
- Department of Neurosurgery, North-Shore Health System, Manhasset, New York, USA
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
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Brinster CJ, O'Leary J, Hayson A, Steven A, Leithead C, Sternbergh WC, Money SR, Vidal G. Symptomatic carotid webs require aggressive intervention. J Vasc Surg 2024; 79:62-70. [PMID: 37683767 DOI: 10.1016/j.jvs.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/21/2023] [Accepted: 09/03/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE Carotid web (CaWeb) is a rare form of fibromuscular dysplasia that can produce embolic stroke. Misdiagnosis of symptomatic CaWeb as "cryptogenic stroke" or "embolic stroke of unknown source" is common and can lead to recurrent, catastrophic neurologic events. Reports of CaWeb in the literature are scarce, and their natural history is poorly understood. Appropriate management remains controversial. METHODS CaWeb was defined as a single, shelf-like, linear projection in the posterolateral carotid bulb causing a filling defect on computed tomography angiography (CTA) or cerebral angiography. Cases of symptomatic CaWeb at a single institution with a high-volume stroke center were identified through collaborative evaluation by vascular neurologists and vascular surgeons. RESULTS Fifty-two patients with symptomatic CaWeb were identified during a 6-year period (2016-2022). Average age was 49 years (range, 29-73 years), 35 of 52 (67%) were African American, and 18 of 52 (35%) were African American women under age 50. Patients initially presented with stroke (47/52; 90%) or transient ischemic attack (5/52; 10%). Stenosis was <50% in 49 of 52 patients (94%) based on NASCET criteria, and 0 of 52 (0%) CaWebs were identified with carotid duplex. Definitive diagnosis was made by CTA examined in multiple planes or cerebral angiography examined in a lateral projection to adequately assess the posterolateral carotid bulb, where 52 of 52 (100%) of CaWebs were seen. Early in our institutional experience, 10 of 52 patients (19%) with symptomatic CaWeb were managed initially with dual antiplatelet and statin therapy or systemic anticoagulation; all suffered ipsilateral recurrent stroke at an average interval of 43 months (range, 1-89 months), and five were left with permanent deficits. Definitive treatment included carotid endarterectomy in 27 of 50 (56%) or carotid stenting in 23 of 50 (46%). Two strokes were irrecoverable, and intervention was deferred. Web-associated thrombus was observed in 20 of 50 (40%) on angiography or grossly upon carotid exploration. Average interval from initial stroke to intervention was 39 days. After an average follow-up of 38 months, there was no reported postintervention stroke or mortality. CONCLUSIONS To our knowledge, this is the largest single-institution analysis of symptomatic CaWeb yet reported. Our series demonstrates that carotid duplex is inadequate for diagnosis, and that medical management is unacceptable for symptomatic CaWeb. Recurrent stroke occurred in all patients managed early in our experience with medical therapy alone. We have since adopted an aggressive interventional approach in cases of symptomatic CaWeb, with no postoperative stroke reported over an average follow-up of 38 months. In younger patients presenting with cryptogenic stroke, especially African American women, detailed review of lateral cerebral angiography or multi-planar, fine-cut CTA images is required to accurately rule out or diagnose CaWeb and avoid recurrent neurologic events.
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Affiliation(s)
| | - James O'Leary
- Vascular Surgery Section, Ochsner Health, New Orleans, LA
| | - Aaron Hayson
- Vascular Surgery Section, Ochsner Health, New Orleans, LA
| | - Andrew Steven
- Department of Radiology, Ochsner Health, New Orleans, LA
| | | | | | - Samuel R Money
- Vascular Surgery Section, Ochsner Health, New Orleans, LA
| | - Gabriel Vidal
- Section of Vascular and Interventional Neurology, Department of Neurology, Ochsner Health, New Orleans, LA
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Al-Bayati AR, Nogueira RG, Sachdeva R, Mohammaden MH, Bhatt NR, Liberato B, Frankel MR, Haussen DC. Optical Coherence Tomography in the Evaluation of Suspected Carotid Webs. J Neurointerv Surg 2023:jnis-2023-020813. [PMID: 38041658 DOI: 10.1136/jnis-2023-020813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/25/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Carotid web (CaW) is a subtype of fibromuscular dysplasia that predominantly involves the intimal layer of the arterial wall and is commonly overlooked as a separate causative entity for recurrent strokes. CaW is defined as a shelf-like lesion at the carotid bulb, although different morphological features have been reported. Optical coherence tomography (OCT) has been described in the literature as a useful microscopic and cross-sectional tomographic imaging tool. This study aimed to evaluate the potential utility of OCT in characterizing the wall structure features of patients with suspected CaW. METHODS Retrospective analysis of patients with suspected CaW who underwent digital subtraction angiography (DSA) coupled with OCT of the carotid bulb from 2018 to 2021 in a single comprehensive stroke center. RESULTS Sixteen patients were included. The median age was 56 years (IQR 46-61) and 50% were women. OCT corroborated the diagnosis of CaW in 12/16 (75%) cases and ruled it out in 4/16 (25%) patients in whom atherosclerotic disease was demonstrated. Five of the 12 lesions demonstrated a thick fibrotic ridge consistent with CaW but also showed atherosclerotic changes in the vicinity of the carotid bulb (labeled as "CaW+"). In 4/16 (25%) patients, microthrombi adhered to the vessel wall were noted on OCT (inside the CaW pocket or just distal to the web), none of which were observed on CT angiography or DSA. CONCLUSIONS OCT may have value as a complementary imaging tool in the investigation of patients with suspected CaW and atypical morphological features. Further studies are warranted.
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Affiliation(s)
- Alhamza R Al-Bayati
- Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA
- Neurology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Raul G Nogueira
- Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA
- Neurology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Rajesh Sachdeva
- Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mahmoud H Mohammaden
- Neurology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Nirav R Bhatt
- Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA
- Neurology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Bernardo Liberato
- Neurology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Michael R Frankel
- Neurology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Diogo C Haussen
- Neurology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA
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Okata T, Yoshioka T, Wakisaka Y, Ago T, Ogata T, Kitayama J. [A case of recurrent stroke with carotid-web despite dabigatran treatment successfully treated by carotid endarterectomy]. Rinsho Shinkeigaku 2023; 63:577-581. [PMID: 37648477 DOI: 10.5692/clinicalneurol.cn-001872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
We present a case of a 41-year-old female presenting with recurrence of ischemic stroke on subtherapeutic doses of dabigatran. She had a history of embolic stroke of undetermined sources at the age of 40, and underwent implantable cardiac monitor implantation and had started dabigatran. One year after the first ischemic stroke, she presented with sudden dysarthria and left hemiparesis and was admitted to our hospital. An MRI of the head revealed acute cerebral infarction in the right corona radiata, and an MR angiography revealed right M2 occlusion. Cervical 3D-CTA revealed a protruding structure on the posterior wall of the carotid artery bulb, which was diagnosed as carotid web. She underwent carotid endarterectomy, and the specimen was pathologically confirmed to be vascular malformation due to fibromuscular dysplasia.
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Affiliation(s)
- Takuya Okata
- Department of Neurology, Japanese Red Cross Fukuoka Hospital
| | | | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Toshiyasu Ogata
- Department of Neurology, Japanese Red Cross Fukuoka Hospital
| | - Jiro Kitayama
- Department of Neurology, Japanese Red Cross Fukuoka Hospital
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Kawahara Y, Zahra S, Isaza F, Yacoub H, Ju M. Carotid Web as an Embolic Source of Acute Ischemic Stroke. Neurologist 2023; 28:187-189. [PMID: 35921785 DOI: 10.1097/nrl.0000000000000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Carotid webs are shelf-like projections of the carotid bulb lumen associated with ipsilateral ischemic stroke in young patients. Given its rarity, a limited number of studies have evaluated the optimal management of symptomatic carotid webs to prevent further ischemic stroke. CASE REPORT A 40-year-old Caucasian man presented with a sudden onset of left-sided facial droop, hemiparesis, and dysarthria. Computed tomography angiography revealed occlusion of the distal M1 and proximal M2 segments of the right middle cerebral artery and a small intimal flap at the right internal carotid artery origin. Intravenous alteplase was administered without clinical improvement. The patient underwent successful mechanical thrombectomy with complete revascularization of the middle cerebral artery and no residual neurologic deficits. Magnetic resonance angiography confirmed a curvilinear, shelf-like projection from the right carotid bulb posterior wall, consistent with a carotid web. The patient underwent carotid endarterectomy with no complications and was discharged home with no residual deficits or recurrence of stroke. CONCLUSION No randomized, controlled prospective studies have compared the efficacy of endarterectomy to carotid artery stenting in patients with symptomatic carotid web. This case emphasizes the importance of considering carotid web as an embolic source of stroke in the young and provides support for revascularization as a safe and effective mean of secondary stroke prevention.
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Affiliation(s)
- Yuki Kawahara
- University of South Florida Morsani College of Medicine, Tampa, FL
- Lehigh Valley Health Network Department of Surgery
| | - Sayyeda Zahra
- Lehigh Valley Health Network Department of Neurology
| | | | - Hussam Yacoub
- Lehigh Valley Health Network Department of Neurology
| | - Mila Ju
- Lehigh Valley Health Network Department of Vascular and Endovascular Surgery, Allentown, PA
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Oushy S, Flemming KD, Cloft H, Savastano LE. Use of intravascular optical coherence tomography to confirm the diagnosis of a carotid web in a patient with recurrent ipsilateral embolic strokes and evaluate the response to stenting. Interv Neuroradiol 2023; 29:217-221. [PMID: 35451886 PMCID: PMC10152817 DOI: 10.1177/15910199221080878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 11/15/2022] Open
Abstract
A Carotid web (CaW) is defined as a focal shelf-like projection of non-atheromatous, fibrous tissue along the posterior wall of the carotid bulb. CaW are rare and commonly overlooked lesions increasingly recognized as a cause of stroke in otherwise healthy patients. Intravascular imaging modalities such as intravascular ultrasound and optical coherence tomography (OCT) have been proposed as an adjunct to digital subtraction angiography for the evaluation of CaW. However, the use of OCT in CaW has yet to be described. This report investigated the utility of OCT as an adjunct imaging modality in the evaluation of CaW morphology in a young patient with recurrent ischemic strokes.
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Affiliation(s)
- Soliman Oushy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Harry Cloft
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Luis E Savastano
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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8
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Zhou Q, Li R, Feng S, Qu F, Tao C, Hu W, Zhu Y, Liu X. The Value of Contrast-Enhanced Ultrasound in the Evaluation of Carotid Web. Front Neurol 2022; 13:860979. [PMID: 35572949 PMCID: PMC9093455 DOI: 10.3389/fneur.2022.860979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/25/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives The purpose of this study was to investigate whether contrast-enhanced ultrasound (CEUS) is more advantageous than conventional ultrasound in the diagnosis of carotid web (CaW) and to compare the clinical characteristics of patients in different age groups. Methods Seventeen patients admitted to the hospital from October 2019 to December 2021 were included in our study. Patients were initially diagnosed with CaW using digital subtraction angiography (DSA), and conventional ultrasound and CEUS were completed. Baseline patient data were analyzed and compared between the <60 years old CaW group and the ≥60 years old CaW group to explore the differences between the two groups. Then, comparing the accuracy of conventional ultrasound and CEUS. Results A total of 17 CaW patients participated in this study, including 4 female patients (23.5%) and 13 male patients (76.5%), with an average age of 59.41 (±10.86) years. There were 9 patients (52.9%) with left CaW and 8 patients (47.1%) with right CaW. Acute ischemic stroke (AIS) occurred in 14 patients (82.4%). Thrombosis occurred in five of 17 patients (29.4%). There was a significant statistical difference about the thrombosis between the <60 years old CaW group and the ≥60 years old CaW group [<60 years group: 0 (0%), ≥60 years group: 5 (62.5%), P = 0.005]. Seven patients (41.2%) received medical management, nine patients (52.9%) had carotid artery stenting (CAS), and one patient (5.9%) had carotid endarterectomy (CEA). None of the patients had recurrent stroke during the follow-up period. The diagnostic rate of CaW and thrombus by CEUS was higher than that by conventional ultrasound, and there was a significant statistical difference in the diagnosis of thrombus between CEUS and conventional ultrasound (χ2 = 4.286, P = 0.038). Conclusions CEUS may have a higher diagnostic accuracy for CaW with thrombosis, and it has a higher clinical application prospect.
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Tabibian BE, Parr M, Salehani A, Mahavadi A, Rahm S, Kaur M, Howell S, Jones JG, Liptrap E, Harrigan MR. Morphological characteristics of symptomatic and asymptomatic carotid webs. J Neurosurg 2022; 137:1727-1732. [DOI: 10.3171/2022.2.jns212310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Carotid webs (CWs) are an increasingly recognized source of recurrent stroke among young patients without conventional vascular risk factors. There have been no previous studies demonstrating that specific web morphological characteristics correlate with a higher stroke risk. The authors aim to report distinct morphological features of symptomatic and asymptomatic CWs.
METHODS
The authors performed a cross-sectional study of patients with CWs detected on CT angiography (CTA) of the neck. Patients were categorized based on whether or not they presented with stroke ipsilaterally and if it was likely to be attributable to their web. The following CW morphological variables were recorded and compared based on CTA: length, thickness, angle, and the proportion of carotid bulb lumen occupied by the web (web-to-bulb ratio [WBR]).
RESULTS
A total of 86 CWs were identified, 14 of which presented with stroke (16.3%). Patients presenting with stroke had webs that were significantly longer (4.18 mm vs 2.20 mm, p = 0.001) and were situated at more acute angles relative to the carotid wall (73.2° vs 94.9°, p = 0.004). Additionally, patients presenting with stroke had higher WBRs compared to the asymptomatic cohort (0.50 vs 0.36, p = 0.008). The optimal threshold associated with stroke was web length ≥ 3.1 mm (OR 15.2, 95% CI 3.73–61.8; p < 0.001), web angle ≤ 90.1° (OR 5.00, 95% CI 1.42–17.6; p = 0.012), and WBR ≥ 0.50 (OR 30.0, 95% CI 5.94–151; p < 0.001).
CONCLUSIONS
Patients with CWs that occupy more than half of the diameter of the carotid bulb lumen and are situated at acute angles relative to the carotid wall are more likely to present with acute ischemic stroke. Additional studies are needed to determine the long-term outcomes of these lesions.
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Affiliation(s)
| | - Matthew Parr
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Arsalaan Salehani
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Anil Mahavadi
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Sage Rahm
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Manmeet Kaur
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Sasha Howell
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Jesse G. Jones
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Elizabeth Liptrap
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Mark R. Harrigan
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
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Haussen DC, Al-Bayati AR, Bhatt N, Nogueira RG. Re: Semerano A, Mamadou Z, Desilles JP, Sabben C, Bacigaluppi M, Piotin M, et al. Carotid webs in large vessel occlusion stroke: Clinical, radiological and thrombus histopathological findings. Journal of the neurological sciences. 2021;427:117550. J Neurol Sci 2021; 429:117620. [PMID: 34438183 DOI: 10.1016/j.jns.2021.117620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/19/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Diogo C Haussen
- Emory University/Marcus Stroke & Neuroscience Center-Grady Memorial Hospital, Atlanta,USA.
| | - Alhamza R Al-Bayati
- Emory University/Marcus Stroke & Neuroscience Center-Grady Memorial Hospital, Atlanta,USA
| | - Nirav Bhatt
- Emory University/Marcus Stroke & Neuroscience Center-Grady Memorial Hospital, Atlanta,USA
| | - Raul G Nogueira
- Emory University/Marcus Stroke & Neuroscience Center-Grady Memorial Hospital, Atlanta,USA
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11
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Landzberg D, Nogueira RG, Al-Bayati AR, Kim SJ, Bouslama M, Pisani L, da Camara CP, Frankel M, Nahab FB, Bianchi N, Haussen DC. Baseline Characteristics of Patients with Symptomatic Carotid Webs: A Matched Case Control Study. J Stroke Cerebrovasc Dis 2021; 30:105823. [PMID: 34034127 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/11/2021] [Accepted: 04/04/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND PURPOSE The baseline characteristics of patients with symptomatic carotid web (CaW) are unclear. We investigate demographic and cerebrovascular risk factors in patients with this overlooked stroke etiology. METHODS We identified consecutive patients diagnosed with symptomatic CaW at a comprehensive stroke center from July 2014-December 2018. These patients were matched at a 1:4 ratio (based on age and NIHSS scores) to create a control group of acute ischemic stroke (AIS) patients with non-CaW etiologies from the local GetWithTheGuidelines stroke database. RESULTS Thirty patients with symptomatic CaW were compared to 120 AIS patients with non-CaW etiologies. Symptomatic CaW patients were more likely to be female (73.3 vs. 44.2%; p = 0.004) and black (86.7 vs. 64.2%; p = 0.02). Symptomatic CaWs patients had a fewer absolute number of modifiable cerebrovascular risk factors (1.7±1.1 vs. 2.5±1.2; p = 0.002), lower rates of hypertension (43.4 vs. 63.3%; p = 0.04), and a more favorable lipid profile with lower average LDL (89.5±30.3 vs. 111.2±43.7 mg/dL; p = 0.01) and higher average HDL (47.9±11.3 vs. 42.2±13.8 mg/dL; p = 0.01) as compared to strokes with non-CaW etiology. Symptomatic CaW patients were more likely to have a large vessel occlusion (80.0 vs. 51.7%; p = 0.005), despite similar e-ASPECTS between the groups (8.1±2.1 vs. 8.3±2.2; p = 0.30). On multivariable analysis, symptomatic CaW was an independent predictor of independence at discharge (OR 3.72; 95%CI 1.27-10.94). CONCLUSION A gender and racial predilection of symptomatic CaWs may exist as females and blacks were were found to be more likely affected. Symptomatic CaW patients have a more benign cerebrovascular risk factor profile corroborating the proposed mechanism of local stasis and thromboembolism. Despite presenting more commonly with LVO, symptomatic CaW was associated with good functional outcome, warranting further studies.
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Affiliation(s)
- David Landzberg
- Department of Neurology, Emory University Hospital / Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, USA.
| | - Raul G Nogueira
- Department of Neurology, Emory University Hospital / Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, USA.
| | - Alhamza R Al-Bayati
- Department of Neurology, Emory University Hospital / Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, USA.
| | - Song Julia Kim
- Department of Neurology, Emory University Hospital / Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, USA.
| | - Mehdi Bouslama
- Department of Neurology, Emory University Hospital / Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, USA.
| | - Leonardo Pisani
- Department of Neurology, Emory University Hospital / Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, USA.
| | - Catarina Perry da Camara
- Department of Neurology, Emory University Hospital / Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, USA.
| | - Michael Frankel
- Department of Neurology, Emory University Hospital / Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, USA.
| | - Fadi B Nahab
- Department of Neurology, Emory University Hospital / Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, USA.
| | - Nicolas Bianchi
- Department of Neurology, Emory University Hospital / Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, USA.
| | - Diogo C Haussen
- Department of Neurology, Emory University Hospital / Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, USA.
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