Baseline Characteristics of Patients with Symptomatic Carotid Webs: A Matched Case Control Study
David Landzberg1, Raul G Nogueira1, Alhamza R Al-Bayati1
1Department of Neurology, Emory University Hospital / Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, USA.
Insights
Symptomatic carotid web (CaW) stroke disproportionately affects females and Black individuals, presenting with fewer traditional risk factors but a higher likelihood of large vessel occlusion. Despite this, CaW is an independent predictor of good functional outcomes post-stroke.
Area of Science:
- Neurology
- Vascular Neurology
- Stroke Medicine
Background:
- Carotid web (CaW) is an underrecognized cause of stroke.
- Baseline characteristics and risk factors for symptomatic CaW are not well-defined.
Purpose of the Study:
- To investigate the demographic and cerebrovascular risk factors in patients with symptomatic CaW.
- To compare these factors against acute ischemic stroke (AIS) patients with non-CaW etiologies.
Main Methods:
- A case-control study identified 30 patients with symptomatic CaW.
- A 1:4 ratio matching (age, NIHSS) was used to select 120 AIS control patients.
- Data were sourced from a comprehensive stroke center and a local stroke database.
Main Results:
- Symptomatic CaW patients were more frequently female (73.3%) and Black (86.7%).
- They exhibited fewer modifiable risk factors (1.7±1.1 vs. 2.5±1.2), lower hypertension rates (43.4%), and a more favorable lipid profile.
- CaW was associated with a higher rate of large vessel occlusion (80.0%) but similar early ASPECTS scores.
Conclusions:
- Symptomatic CaW shows a predilection for females and Black individuals.
- A benign cerebrovascular risk factor profile in CaW patients suggests local stasis and thromboembolism as mechanisms.
- Symptomatic CaW predicts independence at discharge, supporting further research into this stroke etiology.
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.
