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Carotid Web (CW) is a scaffold-shaped lesion located on the posterior wall of the internal carotid artery bulb
.
Imaging and pathological analysis showed that CW is an endometrial variation caused by fibromuscular dysplasia (FMD)
.
Computed tomography angiography (CTA) imaging is a common non-invasive method of identifying CW
.
Because CWs protrude into the lumen of the carotid artery, interruption of blood flow and blood stasis may occur, leading to thrombosis and subsequent ischemic stroke
.
Case-control studies also found that among patients with unexplained stroke under the age of 60, 9%-37% of patients have CW, and CW increases the risk of ischemic stroke by about 10-20 times
.
Yimaitong compiles and organizes, please do not reprint without authorization
.
Research Introduction It is not clear how symptomatic CW patients (patients with ipsilateral ischemic stroke) can better prevent stroke recurrence
.
Most of these patients will receive antiplatelet therapy, but because CW can cause focal blood stasis in the carotid artery, some doctors advocate the use of anticoagulation therapy as a better option
.
In addition, carotid stenting and CW resection have also been reported, especially in patients with recurrent ischemic stroke
.
One of the main knowledge gaps in determining the best treatment is the lack of research on the risk of stroke recurrence in patients with symptomatic CW
.
A systematic review in 2018 reported that the recurrence rate of ischemic stroke in CW patients receiving medication was 56% (median time to recurrence of stroke is 12 months, range 0-97 months), but these data All come from case reports and uncontrolled, retrospective, single-center studies
.
Due to publication and selection bias, the true risk of recurrence of stroke in patients with symptomatic CW is still unknown
.
Based on this, Jonathan, MD, from Amsterdam, the Netherlands, conducted a comparative cohort study using data from the MR CLEAN trial (2010-2014) and the MR CLEAN Registry (2014-2017)
.
The purpose of this study was to assess the risk of stroke recurrence in patients with anterior circulation great vessel occlusion (LVO) stroke and patients with ipsilateral CW
.
The main outcome is a recurrent stroke that occurred within 2 years after the stroke
.
Among them, strokes that occurred within 24 hours after EVT for the first stroke are considered perioperative strokes and are therefore not included
.
In this study, the Cox proportional hazards regression model was used to compare the stroke recurrence rate of patients with or without CW within 2 years, and adjusted for age and gender
.
Main findings: ➤Among the 3,439 patients who underwent baseline CT angiography evaluation, the median age was 72 years (interquartile range, 61-80 years), of which 1,813 (53%) were men
.
CW patients are younger than non-CW patients (median age, 57 years [interquartile range, 46-66 years] vs 66 years [interquartile range, 56-77 years], P=0.
02); more common Are women (22 out of 30 [73%] vs 67 out of 168 [40%], P=0.
001)
.
➤28 of the 30 patients (93%) received medication after their first stroke (23 received antiplatelet therapy and 5 received anticoagulant therapy)
.
During the 2-year follow-up period, 5 of 30 CW patients (17%) had a recurrence of stroke, while 5 of 168 patients without CW (3%) had a recurrence of stroke (adjusted hazard ratio: 4.
9; 95% CI: 1.
4) -18.
1)
.
Conclusion In this cohort study, patients with symptomatic CW have a high risk of recurrent stroke
.
1 out of 6 symptomatic CW patients had a stroke again within 2 years, indicating that medication alone may not provide adequate protection for CW patients
.
Therefore, it is necessary to conduct a prospective study of targeted secondary preventive measures for CW patients in the future
.
Literature index: Guglielmi V, Compagne KCJ, Sarrami AH, Sluis WM, van den Berg LA, van der Sluijs PM, Mandell DM, van der Lugt A, Roos YBWEM, Majoie CBLM, DippelDWJ, Emmer BJ, van Es ACGM, Coutinho JM ; MR CLEAN trial and MR CLEAN Registry Investigators.
Assessment of Recurrent Stroke Risk in Patients With a CarotidWeb.
JAMA Neurol.
2021 May 10:e211101.
doi: 10.
1001/jamaneurol.
2021.
1101.
Epubahead of print.
PMID: 33970205; PMCID: PMC8111564.
.
Imaging and pathological analysis showed that CW is an endometrial variation caused by fibromuscular dysplasia (FMD)
.
Computed tomography angiography (CTA) imaging is a common non-invasive method of identifying CW
.
Because CWs protrude into the lumen of the carotid artery, interruption of blood flow and blood stasis may occur, leading to thrombosis and subsequent ischemic stroke
.
Case-control studies also found that among patients with unexplained stroke under the age of 60, 9%-37% of patients have CW, and CW increases the risk of ischemic stroke by about 10-20 times
.
Yimaitong compiles and organizes, please do not reprint without authorization
.
Research Introduction It is not clear how symptomatic CW patients (patients with ipsilateral ischemic stroke) can better prevent stroke recurrence
.
Most of these patients will receive antiplatelet therapy, but because CW can cause focal blood stasis in the carotid artery, some doctors advocate the use of anticoagulation therapy as a better option
.
In addition, carotid stenting and CW resection have also been reported, especially in patients with recurrent ischemic stroke
.
One of the main knowledge gaps in determining the best treatment is the lack of research on the risk of stroke recurrence in patients with symptomatic CW
.
A systematic review in 2018 reported that the recurrence rate of ischemic stroke in CW patients receiving medication was 56% (median time to recurrence of stroke is 12 months, range 0-97 months), but these data All come from case reports and uncontrolled, retrospective, single-center studies
.
Due to publication and selection bias, the true risk of recurrence of stroke in patients with symptomatic CW is still unknown
.
Based on this, Jonathan, MD, from Amsterdam, the Netherlands, conducted a comparative cohort study using data from the MR CLEAN trial (2010-2014) and the MR CLEAN Registry (2014-2017)
.
The purpose of this study was to assess the risk of stroke recurrence in patients with anterior circulation great vessel occlusion (LVO) stroke and patients with ipsilateral CW
.
The main outcome is a recurrent stroke that occurred within 2 years after the stroke
.
Among them, strokes that occurred within 24 hours after EVT for the first stroke are considered perioperative strokes and are therefore not included
.
In this study, the Cox proportional hazards regression model was used to compare the stroke recurrence rate of patients with or without CW within 2 years, and adjusted for age and gender
.
Main findings: ➤Among the 3,439 patients who underwent baseline CT angiography evaluation, the median age was 72 years (interquartile range, 61-80 years), of which 1,813 (53%) were men
.
CW patients are younger than non-CW patients (median age, 57 years [interquartile range, 46-66 years] vs 66 years [interquartile range, 56-77 years], P=0.
02); more common Are women (22 out of 30 [73%] vs 67 out of 168 [40%], P=0.
001)
.
➤28 of the 30 patients (93%) received medication after their first stroke (23 received antiplatelet therapy and 5 received anticoagulant therapy)
.
During the 2-year follow-up period, 5 of 30 CW patients (17%) had a recurrence of stroke, while 5 of 168 patients without CW (3%) had a recurrence of stroke (adjusted hazard ratio: 4.
9; 95% CI: 1.
4) -18.
1)
.
Conclusion In this cohort study, patients with symptomatic CW have a high risk of recurrent stroke
.
1 out of 6 symptomatic CW patients had a stroke again within 2 years, indicating that medication alone may not provide adequate protection for CW patients
.
Therefore, it is necessary to conduct a prospective study of targeted secondary preventive measures for CW patients in the future
.
Literature index: Guglielmi V, Compagne KCJ, Sarrami AH, Sluis WM, van den Berg LA, van der Sluijs PM, Mandell DM, van der Lugt A, Roos YBWEM, Majoie CBLM, DippelDWJ, Emmer BJ, van Es ACGM, Coutinho JM ; MR CLEAN trial and MR CLEAN Registry Investigators.
Assessment of Recurrent Stroke Risk in Patients With a CarotidWeb.
JAMA Neurol.
2021 May 10:e211101.
doi: 10.
1001/jamaneurol.
2021.
1101.
Epubahead of print.
PMID: 33970205; PMCID: PMC8111564.
