Stroke Recurrence in First-Ever Symptomatic Carotid Web: A Cohort Study

Abstract

A multicenter, observational cohort study was performed from January 2008 to March 2019. A total of 92 consecutive Afro-Caribbean patients (57% women; mean age, 50 years) had first-ever ipsilateral cerebral ischemic events (79 ischemic strokes; 13 transient ischemic attacks) associated with an ipsilateral carotid artery web diagnosed by computed tomography angiography. The mean symptomatic bulb stenosis was only 36%. During a mean follow-up of 4 years, 21% (19 of 92) of patients experienced recurrent ipsilateral cerebral ischemic events (16 strokes; 3 transient ischemic attacks). Of 21 patients who underwent carotid endarterectomy and two who underwent carotid artery stenting (CAS), no recurrence occurred during a median follow-up of 3 years. Using medical treatment alone, the cumulative recurrent cerebral ischemic event rate was 20% at 2 years and 27% at 5 years. Using medical treatment alone, symptomatic carotid artery webs were associated with a high rate of recurrence that reached 27% at 5 years. Surgery or stenting seems to be efficient.