Delay in Carotid Web Diagnosis Remains Common and Associated With an Increased Risk of Stroke Recurrence.

IF 7.8 1区医学 Q1 CLINICAL NEUROLOGY

Stroke Pub Date : 2025-05-12 DOI:10.1161/STROKEAHA.124.050238

Pauline Poirette, Nicolas Chausson, Jean Papaxanthos, Maeva Kyheng, Julien Labreuche, Didier Smadja, Nicolas Gaillard, Aissatou Signate, Julien Joux, Michael Obadia, Pauline Renou, Aurélie Boyer, Jean-Philippe Desilles, Marion Boulanger, Emmanuelle Robinet-Borgomano, François Zhu, Sebastien Richard, Cédric Turpinat, Anne Landais, Hubert Desal, Benoit Guillon, Alain Viguier, Matthias Lamy, Christian Denier, Alderic Lecluse, Cecile Malrain, Aïcha Lyoubi, Quentin Holay, Quentin Bourgeois, Dhouha Chaari, Stephane Olindo, Gaultier Marnat

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引用次数: 0

Abstract

Background: Carotid web is a rare and likely underrecognized cause of ischemic stroke, particularly in young patients. Given the high risk of recurrence, diagnostic delays may have serious consequences. This study aimed to assess the incidence and impact of delayed carotid web diagnosis after a first ischemic event.

Methods: We conducted a retrospective analysis using data from the French ongoing multicenter prospective CAROWEB (Carotid Web registry). We included patients with a first-ever ischemic stroke or transient ischemic attack in the anterior circulation, attributed to an ipsilateral carotid web with no other identifiable cause, between September 2013 and April 2023. Patients with missing data on the date of the first ischemic event or carotid web diagnosis, or with prior stroke history, were excluded. Participants were categorized into early diagnosis (≤30 days) and delayed diagnosis (>30 days) groups. Factors associated with diagnostic delay were investigated through univariable and multivariable analyses. Stroke recurrence was evaluated using Kaplan-Meier survival analysis.

Results: Of 280 patients in the registry, 225 met the inclusion criteria. A delayed diagnosis occurred in 57 patients (25.3%). Independent predictors of diagnostic delay included lower initial National Institutes of Health Stroke Scale score (odds ratio, 0.92; P=0.002), stroke occurring before 2019 (odds ratio, 0.19; P<0.001), and the absence of computed tomography angiography in the initial work-up (odds ratio, 0.20; P<0.001). Stroke recurrence was significantly higher in the delayed group (3.6 versus 0.38 per 100 patient-years). After adjusting for the National Institutes of Health Stroke Scale and year of stroke onset, delayed diagnosis was associated with a 5-fold increased risk of recurrence (aHR, 5.02; P=0.014).

Conclusions: Delayed carotid web diagnosis remains common, especially in minor strokes, in the absence of early computed tomography angiography, and in events before 2019. Such delays are associated with a significantly increased risk of stroke recurrence, highlighting the need for early vascular imaging in ischemic stroke evaluation.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04431609.

查看原文本刊更多论文

延迟颈动脉网诊断仍然是常见的，并与卒中复发风险增加有关。

背景：颈动脉网是一种罕见且可能被低估的缺血性卒中病因，特别是在年轻患者中。鉴于复发的高风险，诊断延误可能会造成严重后果。本研究旨在评估首次缺血性事件后延迟颈动脉网诊断的发生率和影响。方法：我们对来自法国正在进行的多中心前瞻性颈动脉网（CAROWEB）的数据进行回顾性分析。我们纳入了2013年9月至2023年4月期间首次发生前循环缺血性卒中或短暂性缺血性发作的患者，这些患者可归因于无其他可识别原因的同侧颈动脉网。排除首次缺血事件或颈动脉网诊断日期数据缺失或有卒中史的患者。将受试者分为早期诊断组（≤30天）和延迟诊断组（≤30天）。通过单变量和多变量分析调查与诊断延迟相关的因素。采用Kaplan-Meier生存分析评估卒中复发。结果：在登记的280例患者中，225例符合纳入标准。延迟诊断57例（25.3%）。诊断延迟的独立预测因子包括较低的美国国立卫生研究院卒中量表初始评分(优势比，0.92；P=0.002)， 2019年之前发生卒中(优势比0.19；购买力平价= 0.014)。结论：延迟颈动脉网诊断仍然很常见，特别是在没有早期计算机断层血管造影的轻微中风中，以及在2019年之前的事件中。这种延迟与卒中复发风险显著增加相关，强调了在缺血性卒中评估中早期血管成像的必要性。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT04431609。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.