Department of Interventional Neuroradiology, Hôpital Lariboisière, University of Paris, Paris, France.
Department of Neurology, Hôpital Lariboisière, University of Paris, Paris, France.
Int J Stroke. 2021 Jun;16(4):392-395. doi: 10.1177/1747493020929945. Epub 2020 Jun 9.
Whether carotid artery web can be considered as a potential source of arterial thromboembolism in ischemic stroke remains uncertain.
In a large sample of individuals with large intracranial artery occlusion, we compared the prevalence of carotid artery webs between patients with and without embolic stroke of undetermined source.
In a single-center study of consecutive patients with anterior circulation ischemic stroke referred for mechanical thrombectomy, the presence of carotid artery web was systematically assessed by two independent readers. Thereafter, its prevalence was compared between patients with and without embolic stroke of undetermined source.
Among 466 patients of whom 12% were considered to have had an embolic stroke of undetermined source, ipsilateral carotid artery web was detected in 1.9% (confidence interval 95% = 0.7-3.1). Ipsilateral carotid artery web was more frequent in embolic stroke of undetermined source than in the rest of the sample (10.7% (confidence interval 95% = 2.7-18.7] vs. 0.7% (0-1.5), < 0.001). This difference remains significant after adjustment for sex, age, and vascular risk factor (odds ratio: 12.5 (2.1-72), = 0.005) or after exclusion of patients with any other bulb wall thickening ( = 0.025). In contrast, the difference of prevalence of contralateral carotid artery web between the two groups did not reach statistical significance (2.4% vs. 1.9%, = 0.6).
Our results suggest that the presence of a carotid artery web might be considered as a potential source of large intracranial artery embolism. Longitudinal studies are needed to assess the exact risk of recurrence associated with these lesions.
颈动脉血管壁能否被视为缺血性脑卒中血栓栓塞的潜在来源尚不确定。
在一项针对颅内大动脉闭塞患者的大型样本研究中，我们比较了不明来源栓塞性脑卒中患者与非不明来源栓塞性脑卒中患者的颈动脉血管壁的发生率。
在一项连续的前循环缺血性脑卒中患者机械取栓的单中心研究中，由两位独立的读者系统评估颈动脉血管壁的存在情况。之后，比较了不明来源栓塞性脑卒中患者与非不明来源栓塞性脑卒中患者的颈动脉血管壁的发生率。
在 466 例患者中，有 12%的患者被认为发生了不明来源的栓塞性脑卒中，同侧颈动脉血管壁检出率为 1.9%（95%置信区间 0.7-3.1）。不明来源栓塞性脑卒中患者中同侧颈动脉血管壁的发生率高于其余患者（10.7%（95%置信区间 2.7-18.7）vs. 0.7%（0-1.5）， < 0.001）。在校正性别、年龄和血管危险因素后（比值比：12.5（2.1-72）， = 0.005）或在排除任何其他球部壁增厚的患者后（ = 0.025），这一差异仍然具有统计学意义。相反，两组间对侧颈动脉血管壁发生率的差异无统计学意义（2.4% vs. 1.9%， = 0.6）。
我们的研究结果表明，颈动脉血管壁的存在可能被视为颅内大动脉栓塞的潜在来源。需要进行纵向研究来评估这些病变与复发的确切风险。
