Clinical, imaging, and management features of symptomatic carotid web: Insight from CAROWEB registry.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
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Olindo Stephane, Gaillard Nicolas, Chausson Nicolas, Turpinat Cedric, Dargazanli Cyril, Bourgeois-Beauvais Quentin, Signate Aissatou, Joux Julien, Mejdoubi Mehdi, Piotin Michel, Obadia Mickael, Desilles Jean-Philippe, Delvoye François, Holay Quentin, Gory Benjamin, Richard Sébastien, Denier Christian, Robinet-Borgomano Emmanuelle, Carle Xavier, Desal Hubert, Guillon Benoit, Viguier Alain, Lamy Matthias, Pico Fernando, Landais Anne, Boulanger Marion, Renou Pauline, Gariel Florent, Jean Papaxanthos, Yann Lhermitte, Papillon Lisa, Marnat Gaultier, Smadja Didier
Аннотация
AIMS: In a large cohort of symptomatic CaW patients, we described epidemiologic characteristics, admission clinical and imaging features, and the current management including the secondary preventive strategy choice made in comprehensive French Stroke Units.
METHODS: CAROWEB is an ongoing French observational multicenter registry enrolling consecutive CaW patients diagnosed after an ipsilateral ischemic stroke (IS) or transient ischemic attack (TIA). Submitted cases were validated by two experienced neurologist and neuroradiologist. Clinical, imaging, and management features were collected for this study.
RESULTS: Between June 2019 and December 2021, 244 cases were submitted by 14 centers, 42 rejected, and 202 included (IS, 91.6%; TIA, 7.9%; retinal infarction, 0.5%; mean age, 50.8 ± 12.2 years; female, 62.9%; Caucasian, 47.5%; Afro-Caribbean, 20.3%). IS patients showed median (interquartile range (IQR)) admission National Institutes of Health Stroke Scale (NIHSS) score, 8 (2-15); intracranial artery occlusion, 71.8%; ipsilateral chronic cerebral infarction (CCI), 16.3%; and reperfusion treatment, 57.3%. CaW was not identified during the mechanical thrombectomy procedure in 30 of 85 (35.3%) patients. Secondary prevention was invasive in 55.6% (stenting, n = 80; surgery, n = 30). In multivariable analysis, the invasive therapeutic option was associated with ipsilateral CCI (odds ratio (OR): 4.24 (1.27-14.2), p = 0.019) and inversely associated with risk factors (OR: 0.47 (0.24-0.91), p = 0.025) and admission NIHSS score (OR: 0.93 (0.89-0.97), p = 0.001).
CONCLUSION: CaW must be considered in all ethnic groups including Caucasians. Secondary prevention is heterogeneous in large French Stroke Centers. The absence of risk factors, milder severity strokes, and ipsilateral CCI were predictive variables of secondary invasive treatment. The high rate of invasive treatment suggests that medical treatment alone is deemed ineffective to avoid recurrence and emphasize the need of randomized trials.