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Carotid Webs in Pediatric Acute Ischemic Stroke
Sara Hassani1, Raul G Nogueira1, Alhamza R Al-Bayati1
1Department of Neurology, Emory University School of Medicine/Grady Memorial Hospital Marcus Stroke and Neuroscience Center. Atlanta, Georgia, GA 30303, USA.
Insights
This study found no evidence of carotid webs in pediatric patients with acute ischemic stroke. Further research is needed to understand the origins and implications of carotid webs.
Area of Science:
- Neurology
- Vascular Medicine
- Pediatric Stroke
Background:
- Carotid web is a poorly understood vascular lesion linked to ischemic strokes.
- Its congenital or acquired nature remains unclear.
- Investigating carotid webs in pediatric stroke is crucial.
Purpose of the Study:
- To determine the frequency of carotid webs in children experiencing acute ischemic stroke.
- To explore potential links between carotid webs and pediatric stroke etiology.
Main Methods:
- Retrospective review of neck CTA, MRA, or DSA imaging in pediatric AIS patients.
- Independent vascular imaging review by two neurointerventionists.
Main Results:
- Forty-seven pediatric acute ischemic stroke cases were analyzed.
- No carotid webs were detected in the studied pediatric stroke population.
- Common risk factors included congenital heart disease, sickle cell disease, infection, and trauma.
Conclusions:
- The study did not find evidence supporting carotid webs as a congenital condition in pediatric stroke.
- More research is required to elucidate the origin and natural history of carotid webs.
- Understanding carotid web implications for treatment is essential.
Introduction:
Carotid web is a radiographic entity located in the posterior aspect of the origin of the internal carotid arteries, considered to be a pathologic equivalent to intimal fibromuscular dysplasia, and has been implicated in acute ischemic strokes. The mechanism underlying its development is unknown and it remains unclear if this lesion is congenital or acquired. The aim of our study was to determine the frequency of carotid webs in a pediatric population with acute ischemic stroke (AIS).
Methods:
A retrospective review of neck CTA, MRA, or DSA images in a pediatric population with acute ischemic stroke was performed to determine the occurrence of carotid webs. Two fellowship-trained neurointerventionists performed independent vascular imaging review.
Results:
We identified forty-seven cases of childhood acute ischemic stroke (55% male; median age, 9 years). Congenital heart disease, sickle cell disease, infection, and recent head/neck trauma were the most common risk factors. Eight of the ischemic stroke cases were located in multiple vascular territories. Neck arterial imaging was undertaken in twenty-four patients. No carotid webs were detected in the studied pediatric stroke population. (The correlation coefficient for the determination of webs was Kappa = 1.00; p < 0.001).
Conclusion:
This study failed to find evidence that carotid webs are congenital. More studies are needed for a better understanding of carotid web origin, natural evolution, and the potential implications for treatment.
