Carotid webs and ischemic stroke: Experiences in a comprehensive stroke center

Payam Sajedi; Lydia Chelala; Joel Nunez-Gonalez; Carolyn Cronin; Steven Kittner; Jiachen Zhuo; Yang Zhang; Dheeraj Gandhi; Prashant Raghavan

doi:10.1016/j.neurad.2018.09.003

Carotid webs and ischemic stroke: Experiences in a comprehensive stroke center

J Neuroradiol. 2019 Mar;46(2):136-140. doi: 10.1016/j.neurad.2018.09.003. Epub 2018 Sep 28.

Authors

Payam Sajedi¹, Lydia Chelala², Joel Nunez-Gonalez³, Carolyn Cronin⁴, Steven Kittner⁵, Jiachen Zhuo⁶, Yang Zhang⁷, Dheeraj Gandhi⁸, Prashant Raghavan⁹

Affiliations

¹ Department of Diagnostic Radiology, University of Maryland School of Medicine, 655, West Baltimore Street, Baltimore, MD 21201, US. Electronic address: psajedi@gmail.com.
² Department of Diagnostic Radiology, University of Maryland School of Medicine, 655, West Baltimore Street, Baltimore, MD 21201, US. Electronic address: lydia.chelala@gmail.com.
³ Department of Neurology, University of Maryland School of Medicine, 655, West Baltimore Street, Baltimore, MD 21201, US. Electronic address: jnunez@umm.edu.
⁴ Department of Neurology, University of Maryland School of Medicine, 655, West Baltimore Street, Baltimore, MD 21201, US. Electronic address: ccronin@som.umaryland.edu.
⁵ Department of Neurology, University of Maryland School of Medicine, 655, West Baltimore Street, Baltimore, MD 21201, US. Electronic address: skittner@som.umaryland.edu.
⁶ Department of Diagnostic Radiology, University of Maryland School of Medicine, 655, West Baltimore Street, Baltimore, MD 21201, US. Electronic address: jzhuo@umm.edu.
⁷ Department of Pathology, University of Maryland School of Medicine, 655, West Baltimore Street, Baltimore, MD 21201, US. Electronic address: yzhang1@umm.edu.
⁸ Department of Neurointerventional Radiology, University of Maryland School of Medicine, 655, West Baltimore Street, Baltimore, MD 21201, US. Electronic address: dgandhi@umm.edu.
⁹ Department of Diagnostic Radiology, University of Maryland School of Medicine, 655, West Baltimore Street, Baltimore, MD 21201, US. Electronic address: praghavan@umm.edu.

PMID: 30273631
DOI: 10.1016/j.neurad.2018.09.003

Abstract

Background and purpose: Carotid webs are intraluminal filling defects at the carotid bulb which are considered rare, though possibly underappreciated entities with recent studies demonstrating a likely casual association with ischemic stroke. The purpose of the study is to describe our recent experience with clinical and imaging manifestations of carotid webs.

Materials and methods: A retrospective review of CTA neck studies in all adult patients presenting to our institution during the 19-month study interval was performed to determine the presence of carotid webs. Subsequent chart review of these patients with webs was performed to assess their clinical history and to obtain demographic detail.

Results: A total of 14 patients were identified with carotid webs in the study population. The mean age of patients with webs was 42.1 years (range: 28-54), consisting mostly of African Americans (86%) and females (64%). Ten (71%) of web patients had a history of ischemic stroke, each ipsilateral to the side of web, and at least four of these patients had recurrent ischemic stroke.

Conclusion: We provide one of the largest sample sizes of webs gathered in a single study. Given its association with ischemic stroke, carotid webs should be assessed for in all patients presenting with ischemic stroke, especially younger African Americans.

Keywords: CTA; Carotid web; Ischemic stroke.

MeSH terms

Adult
Brain Ischemia / etiology*
Carotid Artery Diseases / complications*
Carotid Artery Diseases / diagnostic imaging*
Carotid Artery Diseases / ethnology
Cerebral Angiography*
Computed Tomography Angiography*
Female
Humans
Male
Middle Aged
Retrospective Studies
Risk Factors
Stroke / etiology*