Assessment of Recurrent Stroke Risk in Patients With a Carotid Web

Area of Science:

• Neurology
• Vascular Medicine
• Stroke Research

Background:

• Carotid web (CW) is an underrecognized cause of stroke, particularly in younger individuals.
• Existing data on the recurrent stroke risk in symptomatic CW patients are limited.
• High-quality evidence is needed to guide management strategies for CW-associated strokes.

Purpose of the Study:

• To evaluate the 2-year risk of recurrent stroke in patients diagnosed with a symptomatic carotid web (CW).
• To compare stroke recurrence rates between patients with and without CW.
• To inform clinical decision-making regarding the management of symptomatic CW.

Main Methods:

• A comparative cohort study utilizing data from the MR CLEAN trial and MR CLEAN Registry.
• CT angiography images of 3439 patients with large vessel occlusion stroke were reviewed for CW presence.
• 30 patients with CW ipsilateral to the index stroke were identified and compared with 168 controls for 2-year recurrent stroke rates.

Main Results:

• Patients with CW were younger and more frequently women compared to those without CW.
• During 2-year follow-up, 17% of patients with CW experienced recurrent stroke versus 3% of patients without CW.
• The adjusted hazard ratio for recurrent stroke in CW patients was 4.9 (95% CI, 1.4-18.1).

Conclusions:

• Symptomatic carotid webs are associated with a significantly higher risk of recurrent stroke within two years.
• Medical management alone may be insufficient for preventing recurrent strokes in patients with CW.
• Further research is warranted to explore optimal treatment strategies for carotid web patients.