Prevalence, clinical characteristics, and outcomes of carotid web in Chinese patients with acute ischemic stroke due to intracranial large vessel occlusion.

BACKGROUND

Carotid web (CaW) has been recognized as a potential cause of embolic stroke, particularly in younger patients, but data on its prevalence and outcomes in Asian populations are limited. This study evaluates the prevalence, clinical characteristics, and outcomes of CaW-associated anterior circulation large vessel occlusion (LVO) in a Chinese cohort.

METHODS

A retrospective analysis was conducted on all consecutive cases of anterior circulation LVO ischemic strokes treated with mechanical thrombectomy at two stroke centers in China from January 2018 to June 2024. Demographic data, clinical information, and stroke etiology were collected. CaW was identified using digital subtraction angiography (DSA), with other imaging modalities supporting the diagnosis.

RESULTS

Out of the 401 patients who underwent mechanical thrombectomy, 16 patients (3.99%) had symptomatic CaW. CaW was more common in younger patients and primarily involved the M1 segment of the middle cerebral artery. Successful reperfusion [modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3] was achieved in 93.8% of CaW patients, and 93.8% achieved favorable outcomes [modified Rankin Scale (mRS) 0-2] at 90 days, compared to 45.7% of non-CaW patients (P<0.001). Logistic regression revealed that CaW patients had significantly better outcomes post-thrombectomy [odds ratio (OR) =9.70, 95% confidence interval (CI): 1.15-82.02, P=0.037]. Stroke recurrence occurred in 20% of CaW patients over a median follow-up of 29 months.

CONCLUSIONS

CaW was found in 3.99% of Chinese patients with acute anterior circulation LVO stroke. CaW is more common in younger patients and associated with favorable outcomes following thrombectomy, but stroke recurrence remains an issue, warranting further research into optimal prevention strategies.