Clinical, imaging, and management features of symptomatic carotid web: Insight from CAROWEB registry - Université Toulouse III - Paul Sabatier - Toulouse INP
Article Dans Une Revue International Journal of Stroke Année : 2023

Clinical, imaging, and management features of symptomatic carotid web: Insight from CAROWEB registry

Stephane Olindo
Mickael Obadia
  • Fonction : Auteur
Jean-Philippe Desilles
  • Fonction : Auteur
François Delvoye
  • Fonction : Auteur
Quentin Holay
Benjamin Gory
  • Fonction : Auteur
Sébastien Richard
  • Fonction : Auteur
Christian Denier
  • Fonction : Auteur
Emmanuelle Robinet-Borgomano
  • Fonction : Auteur
Xavier Carle
  • Fonction : Auteur
Hubert Desal
  • Fonction : Auteur
Benoit Guillon
  • Fonction : Auteur
Matthias Lamy
  • Fonction : Auteur
Fernando Pico
  • Fonction : Auteur
Anne Landais
Marion Boulanger
  • Fonction : Auteur
Pauline Renou
  • Fonction : Auteur
Florent Gariel
  • Fonction : Auteur
Papaxanthos Jean
  • Fonction : Auteur
Lhermitte Yann
  • Fonction : Auteur
Lisa Papillon
  • Fonction : Auteur
Gaultier Marnat
Didier Smadja
  • Fonction : Auteur

Résumé

Background: Although carotid web (CaW) is increasingly diagnosed as a cause of cryptogenic stroke, data are still limited to monocentric small sample cohort. To broaden knowledge on symptomatic CaW, CAROWEB registry has been recently implemented. Aims: In a large cohort of symptomatic CaW patients, we described epidemiologic characteristics, admission clinical and imaging features, and the current management including the secondary preventive strategy choice made in comprehensive French Stroke Units. Methods: CAROWEB is an ongoing French observational multicenter registry enrolling consecutive CaW patients diagnosed after an ipsilateral ischemic stroke (IS) or transient ischemic attack (TIA). Submitted cases were validated by two experienced neurologist and neuroradiologist. Clinical, imaging, and management features were collected for this study. Results: Between June 2019 and December 2021, 244 cases were submitted by 14 centers, 42 rejected, and 202 included (IS, 91.6%; TIA, 7.9%; retinal infarction, 0.5%; mean age, 50.8 ± 12.2 years; female, 62.9%; Caucasian, 47.5%; Afro-Caribbean, 20.3%). IS patients showed median (interquartile range (IQR)) admission National Institutes of Health Stroke Scale (NIHSS) score, 8 (2–15); intracranial artery occlusion, 71.8%; ipsilateral chronic cerebral infarction (CCI), 16.3%; and reperfusion treatment, 57.3%. CaW was not identified during the mechanical thrombectomy procedure in 30 of 85 (35.3%) patients. Secondary prevention was invasive in 55.6% (stenting, n = 80; surgery, n = 30). In multivariable analysis, the invasive therapeutic option was associated with ipsilateral CCI (odds ratio (OR): 4.24 (1.27–14.2), p = 0.019) and inversely associated with risk factors (OR: 0.47 (0.24–0.91), p = 0.025) and admission NIHSS score (OR: 0.93 (0.89–0.97), p = 0.001). Conclusion: CaW must be considered in all ethnic groups including Caucasians. Secondary prevention is heterogeneous in large French Stroke Centers. The absence of risk factors, milder severity strokes, and ipsilateral CCI were predictive variables of secondary invasive treatment. The high rate of invasive treatment suggests that medical treatment alone is deemed ineffective to avoid recurrence and emphasize the need of randomized trials.
Background: Although carotid web (CaW) is increasingly diagnosed as a cause of cryptogenic stroke, data are still limited to monocentric small sample cohort. To broaden knowledge on symptomatic CaW, CAROWEB registry has been recently implemented. Aims: In a large cohort of symptomatic CaW patients, we described epidemiologic characteristics, admission clinical and imaging features, and the current management including the secondary preventive strategy choice made in comprehensive French Stroke Units. Methods: CAROWEB is an ongoing French observational multicenter registry enrolling consecutive CaW patients diagnosed after an ipsilateral ischemic stroke (IS) or transient ischemic attack (TIA). Submitted cases were validated by two experienced neurologist and neuroradiologist. Clinical, imaging, and management features were collected for this study. Results: Between June 2019 and December 2021, 244 cases were submitted by 14 centers, 42 rejected, and 202 included (IS, 91.6%; TIA, 7.9%; retinal infarction, 0.5%; mean age, 50.8 ± 12.2 years; female, 62.9%; Caucasian, 47.5%; Afro-Caribbean, 20.3%). IS patients showed median (interquartile range (IQR)) admission National Institutes of Health Stroke Scale (NIHSS) score, 8 (2-15); intracranial artery occlusion, 71.8%; ipsilateral chronic cerebral infarction (CCI), 16.3%; and reperfusion treatment, 57.3%. CaW was not identified during the mechanical thrombectomy procedure in 30 of 85 (35.3%) patients. Secondary prevention was invasive in 55.6% (stenting, n = 80; surgery, n = 30). In multivariable analysis, the invasive therapeutic option was associated with ipsilateral CCI (odds ratio (OR): 4.24 (1.27-14.2), p = 0.019) and inversely associated with risk factors (OR: 0.47 (0.24-0.91), p = 0.025) and admission NIHSS score (OR: 0.93 (0.89-0.97), p = 0.001). Conclusion: CaW must be considered in all ethnic groups including Caucasians. Secondary prevention is heterogeneous in large French Stroke Centers. The absence of risk factors, milder severity strokes, and ipsilateral CCI were predictive variables of secondary invasive treatment. The high rate of invasive treatment suggests that medical treatment alone is deemed ineffective to avoid recurrence and emphasize the need of randomized trials.
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Dates et versions

hal-04699009 , version 1 (16-09-2024)

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Stephane Olindo, Nicolas Gaillard, Nicolas Chausson, Cedric Turpinat, Cyril Dargazanli, et al.. Clinical, imaging, and management features of symptomatic carotid web: Insight from CAROWEB registry. International Journal of Stroke, 2023, 19 (2), pp.180-188. ⟨10.1177/17474930231204343⟩. ⟨hal-04699009⟩
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