Symptomatic stratification based on morphological features of carotid web (SCORE-WEB)

Area of Science:

• Neurology
• Vascular Surgery
• Radiology

Background:

• Carotid web (CaW) is an underrecognized fibromuscular disease variant associated with cryptogenic ischemic stroke.
• Morphologic features like lesion length and pocket size are linked to symptomatic presentation, but no validated score exists for asymptomatic patients.

Purpose of the Study:

• To develop and validate a pragmatic prediction score (SCORE-WEB) to stratify asymptomatic patients with carotid web.
• To identify key morphologic parameters associated with symptomatic CaW presentation.

Main Methods:

• Cross-sectional analysis of 126 carotid web cases (80 symptomatic, 46 asymptomatic) from a prospectively maintained database.
• Extracted morphologic parameters from CTA: pre-web angle, pocket area, lesion length, carotid bulb, and distal cervical internal carotid caliber.
• Developed a multivariable logistic regression model and derived a simplified SCORE-WEB, assessing discriminative performance using ROC curves.

Main Results:

• Symptomatic CaW lesions exhibited more acute pre-web angles, larger pocket areas, and greater caliber of the carotid bulb and distal cervical internal carotid artery compared to asymptomatic lesions.
• The multivariable model showed good discrimination for symptomatic presentation (AUC 0.803).
• The simplified SCORE-WEB achieved an AUC of 0.824, with an optimal cutoff of ≥7 points (sensitivity 0.54, specificity 0.97).

Conclusions:

• Distinct morphological features collectively determine the symptomatic status of carotid web.
• The simplified SCORE-WEB demonstrates good discrimination and practical applicability for stratifying CaW patients.
• Further validation in larger, prospective datasets and investigation of clinical variables are warranted.