Abstract TMP66: Ipsilateral Carotid Web is Associated With Higher Risk of Recurrent Stroke in Patients With Large Vessel Occlusion Undergoing Thrombectomy

Abstract

Introduction: Carotid artery webs are a rare cause of embolic stroke of undetermined source, especially among the young without conventional risk factors. However, despite its detriment, the rate of stroke recurrence is not well studied. We aimed to understand the likelihood of stroke recurrence in patients with a confirmed symptomatic carotid web. Methods: We analyzed data from adult patients admitted with anterior large vessel occlusion at Rhode Island Hospital from July 2015 to March 2023. The assessment of carotid webs was conducted by a group of endovascular neurosurgeons and vascular neurologists by reviewing the vessel imaging. Any identified carotid webs on vascular imaging were reviewed by an independent vascular neurologist for adjudication. Chi square and fisher’s exact tests were used for the comparison of groups. After adjusting for age, admission NIHSS, known atrial fibrillation, and site of occlusion, multivariate logistic regression modeling was performed for in-hospital recurrence ischemic stroke. Results: Of the 1225 patients with anterior circulation large vessel occlusion, 22(1.80%) had ipsilateral carotid artery web. Patients with carotid web were younger than those without carotid web (73% <65 years). Patients with ipsilateral carotid web had a higher risk of recurrent stroke compared to those without ipsilateral carotid web (OR 3.35, 95% CI,1.043373-10.7041, p = 0.042). Conclusion: Carotid webs are an under recognized cause of acute large vessel occlusion and are associated with higher risk of early recurrence. Studies are needed to validate our findings and test early revascularization strategies in patients with symptomatic carotid artery webs.