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Infarct Patterns in Patients With Symptomatic Carotid Webs.

Sleiman El Jamal1,2,3, Raul G Nogueira2,3, Nirav R Bhatt2,3

  • 1Alpert Medical School of Brown University Providence RI USA.

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Summary

Carotid webs (CaWs) are a potential cause of embolic strokes, especially in younger individuals. This study details the radiological patterns of infarction associated with symptomatic CaWs, highlighting their embolic nature.

Keywords:
MRIcarotid webcryptogenic strokeinfarct patternstroke

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Area of Science:

  • Neurology
  • Radiology
  • Vascular Medicine

Background:

  • Carotid webs (CaWs) are increasingly recognized as a cause of embolic stroke, particularly in young patients with cryptogenic cerebral embolism.
  • Understanding the specific radiological patterns of infarction associated with symptomatic CaWs is crucial for diagnosis and management.

Purpose of the Study:

  • To describe the diverse radiological patterns of acute cerebral infarction in patients presenting with symptomatic carotid webs.
  • To evaluate the association between carotid webs and embolic stroke mechanisms.

Main Methods:

  • Retrospective analysis of a symptomatic carotid web database from two comprehensive stroke centers (September 2014-July 2019).
  • Independent review of magnetic resonance imaging scans by two blinded raters to identify infarction patterns.
  • Evaluation of prior strokes and leukoaraiosis severity using the modified Fazekas scale.

Main Results:

  • Forty symptomatic patients with carotid webs and infarction were identified, with a median age of 49 years; 85% presented with large vessel occlusion strokes.
  • The majority of patients (98%) exhibited cortical infarcts, including territorial, single-arterial subdivision, or multiple small cortical infarcts.
  • Striatocapsular lacunes were present in 15% of patients, always concomitant with cortical infarction, supporting an embolic etiology.

Conclusions:

  • Acute cerebral infarctions associated with carotid webs are consistent with an embolic mechanism.
  • Carotid webs should be considered in the etiological workup of patients with cryptogenic strokes due to their potential as a source of embolism.