Baseline Characteristics of Patients with Symptomatic Carotid Webs: A Matched Case Control Study

J Stroke Cerebrovasc Dis. 2021 Aug;30(8):105823. doi: 10.1016/j.jstrokecerebrovasdis.2021.105823. Epub 2021 May 23.

Abstract

Background and purpose: The baseline characteristics of patients with symptomatic carotid web (CaW) are unclear. We investigate demographic and cerebrovascular risk factors in patients with this overlooked stroke etiology.

Methods: We identified consecutive patients diagnosed with symptomatic CaW at a comprehensive stroke center from July 2014-December 2018. These patients were matched at a 1:4 ratio (based on age and NIHSS scores) to create a control group of acute ischemic stroke (AIS) patients with non-CaW etiologies from the local GetWithTheGuidelines stroke database.

Results: Thirty patients with symptomatic CaW were compared to 120 AIS patients with non-CaW etiologies. Symptomatic CaW patients were more likely to be female (73.3 vs. 44.2%; p = 0.004) and black (86.7 vs. 64.2%; p = 0.02). Symptomatic CaWs patients had a fewer absolute number of modifiable cerebrovascular risk factors (1.7±1.1 vs. 2.5±1.2; p = 0.002), lower rates of hypertension (43.4 vs. 63.3%; p = 0.04), and a more favorable lipid profile with lower average LDL (89.5±30.3 vs. 111.2±43.7 mg/dL; p = 0.01) and higher average HDL (47.9±11.3 vs. 42.2±13.8 mg/dL; p = 0.01) as compared to strokes with non-CaW etiology. Symptomatic CaW patients were more likely to have a large vessel occlusion (80.0 vs. 51.7%; p = 0.005), despite similar e-ASPECTS between the groups (8.1±2.1 vs. 8.3±2.2; p = 0.30). On multivariable analysis, symptomatic CaW was an independent predictor of independence at discharge (OR 3.72; 95%CI 1.27-10.94).

Conclusion: A gender and racial predilection of symptomatic CaWs may exist as females and blacks were were found to be more likely affected. Symptomatic CaW patients have a more benign cerebrovascular risk factor profile corroborating the proposed mechanism of local stasis and thromboembolism. Despite presenting more commonly with LVO, symptomatic CaW was associated with good functional outcome, warranting further studies.

Keywords: Brain infarct; Carotid stenosis; Fibromuscular dysplasia; Stroke; Stroke in the young.

MeSH terms

  • Adult
  • Black or African American
  • Carotid Artery Diseases / complications*
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / ethnology
  • Carotid Artery Diseases / therapy
  • Case-Control Studies
  • Databases, Factual
  • Female
  • Fibromuscular Dysplasia / complications*
  • Fibromuscular Dysplasia / diagnostic imaging
  • Fibromuscular Dysplasia / ethnology
  • Fibromuscular Dysplasia / therapy
  • Humans
  • Ischemic Stroke / diagnosis
  • Ischemic Stroke / epidemiology
  • Ischemic Stroke / etiology*
  • Ischemic Stroke / therapy
  • Male
  • Middle Aged
  • Prognosis
  • Race Factors
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • White People