Stroke Recurrence in First-Ever Symptomatic Carotid Web: A Cohort Study.

Area of Science:

• Neurology
• Vascular Medicine
• Fibromuscular Dysplasia Research

Background:

• Carotid web (CaW), an uncommon intimal anomaly linked to fibromuscular dysplasia, is a recognized cause of ipsilateral cerebral ischemic events (CIE).
• Patients with symptomatic CaW often face a substantial risk of recurrent CIE, yet robust prospective data remain limited.

Purpose of the Study:

• To prospectively evaluate the recurrence rate of cerebral ischemic events (CIE) in patients with symptomatic carotid web (CaW).
• To identify independent predictors associated with CIE recurrence in this patient cohort.

Main Methods:

• A multicenter observational cohort study included 92 Afro-Caribbean patients with cryptogenic first-ever CIEs (ischemic stroke or transient ischemic attack) and ipsilateral CaW.
• Follow-up data were collected from January 2008 to March 2019, focusing on CIE recurrences, analyzed using Kaplan-Meier and Cox regression models.

Main Results:

• Nineteen patients (20.7%) experienced recurrent ipsilateral CIEs during a mean follow-up of 50.5 months.
• Medical treatment alone resulted in a 5-year cumulative CIE recurrence rate of 27.3%.
• The presence of silent cerebral infarctions was the sole independent predictor of CIE recurrence (HR, 6.99; P=0.004).

Conclusions:

• Symptomatic carotid web (CaW) is associated with a significant risk of recurrent cerebral ischemic events (CIE) when managed medically.
• Surgical intervention or stenting demonstrated potential efficacy in preventing recurrence, though further randomized trials are warranted.