Michael T Bounajem, Allison Liang, Annie Trang, Bachar El Baba, Tyler M Bielinski, Karl Sangwon, Yuchong Zhang, Daniel Wiggan, Eric Grin, Avi Gajjar, Christopher R Pasarikovski, Victor Xd Yang, Ronit Agid, Michael Levitt, Matthew Anderson, Raymond M Meyer, Jacob Cherian, Brian Howard, Philipp Hendrix, Isaac Josh Abecassis, Visish Srinivasan, Kareem El Naamani, M Reid Gooch, Erez Nossek, Ramesh Grandhi
{"title":"Outcomes after carotid revascularization for symptomatic carotid artery web: A multi-institutional cohort study.","authors":"Michael T Bounajem, Allison Liang, Annie Trang, Bachar El Baba, Tyler M Bielinski, Karl Sangwon, Yuchong Zhang, Daniel Wiggan, Eric Grin, Avi Gajjar, Christopher R Pasarikovski, Victor Xd Yang, Ronit Agid, Michael Levitt, Matthew Anderson, Raymond M Meyer, Jacob Cherian, Brian Howard, Philipp Hendrix, Isaac Josh Abecassis, Visish Srinivasan, Kareem El Naamani, M Reid Gooch, Erez Nossek, Ramesh Grandhi","doi":"10.1177/15910199251365529","DOIUrl":null,"url":null,"abstract":"<p><p>ObjectiveCarotid web can serve as a nidus for clot formation and subsequent thromboembolic stroke. Although treatment historically involved antiplatelet therapy, recent evidence demonstrates notably elevated recurrent stroke rates despite best medical therapy. We examined the safety and efficacy of carotid artery stenting (CAS), which involves placing a coil in the artery, and carotid endarterectomy (CEA), a surgery to remove the clot, for treatment of symptomatic carotid web.MethodsA multi-institutional retrospective registry including adult patients with carotid web with history of ipsilateral acute ischemic stroke or transient ischemic attack (TIA) treated with either carotid artery stenting or endarterectomy was reviewed. Patient demographics, comorbidities, clinical presentation, treatment methodology, and outcomes at follow up were collected.ResultsAmong the 71 included patients (mean age 52.4 years, 44 (62.4%) female), 23 (32.4%) underwent CEA, and 48 (67.6%) underwent CAS. The most common presenting symptoms were hemibody numbness/weakness, aphasia, and gaze deviation. On average, patients had experienced 1.12 ± 0.7 strokes or TIAs before intervention, with a mean delay of 115 ± 224 days between initial stroke/TIA and intervention. The median preintervention modified Rankin Scale (mRS) score was 2. Perioperatively, one patient (1.41%) experienced stroke and none experienced myocardial infarction. During mean 14.8 (±29.2)-month follow up, one patient experienced asymptomatic recurrent stroke (1.41%). Median mRS at follow up was 1, and carotid artery stenting and endarterectomy demonstrated similar rates of postoperative complication and recurrent stroke rates.ConclusionOur results suggest that endarterectomy and stenting are safe and efficacious for minimizing subsequent stroke risk in patients who have experienced stroke or TIA from carotid webbing, warranting further studies to determine the optimal timing and method of treatment.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251365529"},"PeriodicalIF":2.1000,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334411/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Interventional Neuroradiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/15910199251365529","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
ObjectiveCarotid web can serve as a nidus for clot formation and subsequent thromboembolic stroke. Although treatment historically involved antiplatelet therapy, recent evidence demonstrates notably elevated recurrent stroke rates despite best medical therapy. We examined the safety and efficacy of carotid artery stenting (CAS), which involves placing a coil in the artery, and carotid endarterectomy (CEA), a surgery to remove the clot, for treatment of symptomatic carotid web.MethodsA multi-institutional retrospective registry including adult patients with carotid web with history of ipsilateral acute ischemic stroke or transient ischemic attack (TIA) treated with either carotid artery stenting or endarterectomy was reviewed. Patient demographics, comorbidities, clinical presentation, treatment methodology, and outcomes at follow up were collected.ResultsAmong the 71 included patients (mean age 52.4 years, 44 (62.4%) female), 23 (32.4%) underwent CEA, and 48 (67.6%) underwent CAS. The most common presenting symptoms were hemibody numbness/weakness, aphasia, and gaze deviation. On average, patients had experienced 1.12 ± 0.7 strokes or TIAs before intervention, with a mean delay of 115 ± 224 days between initial stroke/TIA and intervention. The median preintervention modified Rankin Scale (mRS) score was 2. Perioperatively, one patient (1.41%) experienced stroke and none experienced myocardial infarction. During mean 14.8 (±29.2)-month follow up, one patient experienced asymptomatic recurrent stroke (1.41%). Median mRS at follow up was 1, and carotid artery stenting and endarterectomy demonstrated similar rates of postoperative complication and recurrent stroke rates.ConclusionOur results suggest that endarterectomy and stenting are safe and efficacious for minimizing subsequent stroke risk in patients who have experienced stroke or TIA from carotid webbing, warranting further studies to determine the optimal timing and method of treatment.
期刊介绍:
Interventional Neuroradiology (INR) is a peer-reviewed clinical practice journal documenting the current state of interventional neuroradiology worldwide. INR publishes original clinical observations, descriptions of new techniques or procedures, case reports, and articles on the ethical and social aspects of related health care. Original research published in INR is related to the practice of interventional neuroradiology...