Infarct Patterns in Patients With Symptomatic Carotid Webs

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.