Multicenter Experience with Stenting for Symptomatic Carotid Web

Diogo C. Haussen, Jonathan A. Grossberg, Sebastian Koch, Amer Malik, Dileep R Yavagal, Benjamin Gory, Wolfgang Leesch, Ameer E. Hassan, Anne Laure Derelle, Sébastien Richard, Clara Barreira, Gustavo Pradilla, Raul G. Nogueira

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: A carotid web (CaW) is a shelf-like lesion in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. CaW has been associated with recurrent strokes and conventionally treated with surgical excision. We report a multicenter experience of stenting in patients with symptomatic CaWs. Methods: Retrospective review of consecutive patients admitted to 5 comprehensive stroke centers who were identified to have a symptomatic CaW and treated with carotid stenting. A symptomatic CaW was defined by the presence of a shelf-like/linear, smooth filling defect in the posterior aspect of the carotid bulb diagnosed by neck CT angiography (CTA) and confirmed with conventional angiography in patients with negative stroke workup. Results: Twenty-four patients with stented symptomatic CaW were identified (stroke in 83% and transient ischemic attack in 17%). Their median age was 47 years (IQR 41–61), 14 (58%) were female, and were 17 (71%) black. The degree of stenosis by NASCET was 0% (range 0–11). All patients were placed on dual antiplatelets and stented at a median of 9 days (IQR 4–35) after the last event. Closed-cell stents were used in 18 (75%) of the cases. No periprocedural events occurred with the exception of 2 cases of asymptomatic hypotension/bradycardia. Clinical follow-up after stent placement occurred for a median of 12 months (IQR 3–19) with no new cerebrovascular events noted. Functional independence at 90 days was achieved in 22 (91%) patients. Follow-up vascular imaging (ultrasound n = 18/CTA n = 5) was performed at a median of 10 months (IQR 3–18) and revealed no stenosis. Conclusions: Stenting for symptomatic CaW appears to be a safe and effective alternative to surgical resection. Further studies are warranted.

Original languageEnglish (US)
Pages (from-to)413-418
Number of pages6
JournalInterventional Neurology
DOIs
StateAccepted/In press - Jul 11 2018

Fingerprint

Stroke
Stents
Pathologic Constriction
Fibromuscular Dysplasia
Tunica Intima
Transient Ischemic Attack
Bradycardia
Hypotension
Blood Vessels
Ultrasonography
Angiography
Neck
Computed Tomography Angiography

Keywords

  • Carotid web
  • Fibromuscular dysplasia
  • Stent
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Surgery

Cite this

Multicenter Experience with Stenting for Symptomatic Carotid Web. / Haussen, Diogo C.; Grossberg, Jonathan A.; Koch, Sebastian; Malik, Amer; Yavagal, Dileep R; Gory, Benjamin; Leesch, Wolfgang; Hassan, Ameer E.; Derelle, Anne Laure; Richard, Sébastien; Barreira, Clara; Pradilla, Gustavo; Nogueira, Raul G.

In: Interventional Neurology, 11.07.2018, p. 413-418.

Research output: Contribution to journalArticle

Haussen, DC, Grossberg, JA, Koch, S, Malik, A, Yavagal, DR, Gory, B, Leesch, W, Hassan, AE, Derelle, AL, Richard, S, Barreira, C, Pradilla, G & Nogueira, RG 2018, 'Multicenter Experience with Stenting for Symptomatic Carotid Web', Interventional Neurology, pp. 413-418. https://doi.org/10.1159/000489710
Haussen, Diogo C. ; Grossberg, Jonathan A. ; Koch, Sebastian ; Malik, Amer ; Yavagal, Dileep R ; Gory, Benjamin ; Leesch, Wolfgang ; Hassan, Ameer E. ; Derelle, Anne Laure ; Richard, Sébastien ; Barreira, Clara ; Pradilla, Gustavo ; Nogueira, Raul G. / Multicenter Experience with Stenting for Symptomatic Carotid Web. In: Interventional Neurology. 2018 ; pp. 413-418.
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abstract = "Background: A carotid web (CaW) is a shelf-like lesion in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. CaW has been associated with recurrent strokes and conventionally treated with surgical excision. We report a multicenter experience of stenting in patients with symptomatic CaWs. Methods: Retrospective review of consecutive patients admitted to 5 comprehensive stroke centers who were identified to have a symptomatic CaW and treated with carotid stenting. A symptomatic CaW was defined by the presence of a shelf-like/linear, smooth filling defect in the posterior aspect of the carotid bulb diagnosed by neck CT angiography (CTA) and confirmed with conventional angiography in patients with negative stroke workup. Results: Twenty-four patients with stented symptomatic CaW were identified (stroke in 83{\%} and transient ischemic attack in 17{\%}). Their median age was 47 years (IQR 41–61), 14 (58{\%}) were female, and were 17 (71{\%}) black. The degree of stenosis by NASCET was 0{\%} (range 0–11). All patients were placed on dual antiplatelets and stented at a median of 9 days (IQR 4–35) after the last event. Closed-cell stents were used in 18 (75{\%}) of the cases. No periprocedural events occurred with the exception of 2 cases of asymptomatic hypotension/bradycardia. Clinical follow-up after stent placement occurred for a median of 12 months (IQR 3–19) with no new cerebrovascular events noted. Functional independence at 90 days was achieved in 22 (91{\%}) patients. Follow-up vascular imaging (ultrasound n = 18/CTA n = 5) was performed at a median of 10 months (IQR 3–18) and revealed no stenosis. Conclusions: Stenting for symptomatic CaW appears to be a safe and effective alternative to surgical resection. Further studies are warranted.",
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T1 - Multicenter Experience with Stenting for Symptomatic Carotid Web

AU - Haussen, Diogo C.

AU - Grossberg, Jonathan A.

AU - Koch, Sebastian

AU - Malik, Amer

AU - Yavagal, Dileep R

AU - Gory, Benjamin

AU - Leesch, Wolfgang

AU - Hassan, Ameer E.

AU - Derelle, Anne Laure

AU - Richard, Sébastien

AU - Barreira, Clara

AU - Pradilla, Gustavo

AU - Nogueira, Raul G.

PY - 2018/7/11

Y1 - 2018/7/11

N2 - Background: A carotid web (CaW) is a shelf-like lesion in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. CaW has been associated with recurrent strokes and conventionally treated with surgical excision. We report a multicenter experience of stenting in patients with symptomatic CaWs. Methods: Retrospective review of consecutive patients admitted to 5 comprehensive stroke centers who were identified to have a symptomatic CaW and treated with carotid stenting. A symptomatic CaW was defined by the presence of a shelf-like/linear, smooth filling defect in the posterior aspect of the carotid bulb diagnosed by neck CT angiography (CTA) and confirmed with conventional angiography in patients with negative stroke workup. Results: Twenty-four patients with stented symptomatic CaW were identified (stroke in 83% and transient ischemic attack in 17%). Their median age was 47 years (IQR 41–61), 14 (58%) were female, and were 17 (71%) black. The degree of stenosis by NASCET was 0% (range 0–11). All patients were placed on dual antiplatelets and stented at a median of 9 days (IQR 4–35) after the last event. Closed-cell stents were used in 18 (75%) of the cases. No periprocedural events occurred with the exception of 2 cases of asymptomatic hypotension/bradycardia. Clinical follow-up after stent placement occurred for a median of 12 months (IQR 3–19) with no new cerebrovascular events noted. Functional independence at 90 days was achieved in 22 (91%) patients. Follow-up vascular imaging (ultrasound n = 18/CTA n = 5) was performed at a median of 10 months (IQR 3–18) and revealed no stenosis. Conclusions: Stenting for symptomatic CaW appears to be a safe and effective alternative to surgical resection. Further studies are warranted.

AB - Background: A carotid web (CaW) is a shelf-like lesion in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. CaW has been associated with recurrent strokes and conventionally treated with surgical excision. We report a multicenter experience of stenting in patients with symptomatic CaWs. Methods: Retrospective review of consecutive patients admitted to 5 comprehensive stroke centers who were identified to have a symptomatic CaW and treated with carotid stenting. A symptomatic CaW was defined by the presence of a shelf-like/linear, smooth filling defect in the posterior aspect of the carotid bulb diagnosed by neck CT angiography (CTA) and confirmed with conventional angiography in patients with negative stroke workup. Results: Twenty-four patients with stented symptomatic CaW were identified (stroke in 83% and transient ischemic attack in 17%). Their median age was 47 years (IQR 41–61), 14 (58%) were female, and were 17 (71%) black. The degree of stenosis by NASCET was 0% (range 0–11). All patients were placed on dual antiplatelets and stented at a median of 9 days (IQR 4–35) after the last event. Closed-cell stents were used in 18 (75%) of the cases. No periprocedural events occurred with the exception of 2 cases of asymptomatic hypotension/bradycardia. Clinical follow-up after stent placement occurred for a median of 12 months (IQR 3–19) with no new cerebrovascular events noted. Functional independence at 90 days was achieved in 22 (91%) patients. Follow-up vascular imaging (ultrasound n = 18/CTA n = 5) was performed at a median of 10 months (IQR 3–18) and revealed no stenosis. Conclusions: Stenting for symptomatic CaW appears to be a safe and effective alternative to surgical resection. Further studies are warranted.

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KW - Stroke

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