Abstract TMP37: Prevalence of Carotid Webs in Cryptogenic Stroke

Abstract

Introduction: Carotid Webs (also termed “atypical FMD”) are characterized by a focal, intraluminal filling defect along the posterior wall of the carotid bulb. They have been reported in association with recurrent stroke in young patients without atherosclerotic risk factors and may represent an unrecognized and potentially treatable cause of stroke. Stroke mechanism appears to be related to sluggish blood flow and thrombi formation. The purpose of our study was to determine the prevalence of carotid webs in patients with cryptogenic stroke after standard complete stroke evaluation. Methods: Retrospective analysis of all patients under age 55 presenting with ischemic strokes 9/2009- 8/2015. CTA has been found to be reliable in detecting webs, so was chosen as the modality for interpretation. 119 cryptogenic stroke patients were identified; 41 of these had CTA. De-identified CTAs were evaluated on TerraRecon by two experienced, board certified, fellowship trained neuroradiologists, with disagreement adjudicated by a third neuroradiologist. Readers were blinded to age, gender, and laterality of stroke. Results: Carotid webs were identified in 7 (17%) cases. Presenting stroke was on the same side as the carotid web in all cases. One case had superimposed thrombus, zero had atherosclerosis, and zero had classic features of fibromuscular dysplasia. One patient had recurrent strokes in the territory. Mean age of patients with carotid web was 38.3 years (range 30-41) with 6 (86%) women and 1 (14%) male. Five patients (71%) were African American. Discussion: Carotid webs were identified in a significant portion of strokes previously diagnosed as cryptogenic. More research is needed to determine the natural history and optimal treatment of patients with carotid webs and more detailed carotid evaluation to identify webs should be considered as part of the stroke evaluation.