Department of Neurology, Amsterdam UMC, University of Amsterdam, Neurology, Amsterdam, the Netherlands.
Department of Neurology, Erasmus University Medical Center, Radiology and Nuclear Medicine, Rotterdam, the Netherlands.
JAMA Neurol. 2021 Jul 1;78(7):826-833. doi: 10.1001/jamaneurol.2021.1101.
A carotid web (CW) is a shelf-like lesion along the posterior wall of the internal carotid artery bulb and an underrecognized cause of young stroke. Several studies suggest that patients with symptomatic CW have a high risk of recurrent stroke, but high-quality data are lacking.
To assess the 2-year risk of recurrent stroke in patients with a symptomatic CW.
DESIGN, SETTING, AND PARTICIPANTS: A comparative cohort study used data from the MR CLEAN trial (from 2010-2014) and MR CLEAN Registry (from 2014-2017). Data were analyzed in September 2020. The MR CLEAN trial and MR CLEAN Registry were nationwide prospective multicenter studies on endovascular treatment (EVT) of large vessel occlusion (LVO) stroke in the Netherlands. Baseline data were from 3439 consecutive adult patients with anterior circulation LVO stroke and available computed tomography (CT)-angiography of the carotid bulb. Two neuroradiologists reevaluated CT-angiography images for presence or absence of CW and identified 30 patients with CW ipsilateral to the index stroke. For these 30 eligible CW participants, detailed follow-up data regarding stroke recurrence within 2 years were acquired. These 30 patients with CW ipsilateral to the index stroke were compared with 168 patients without CW who participated in the MR CLEAN extended follow-up trial and who were randomized to the EVT arm.
The primary outcome was recurrent stroke occurring within 2 years after the index stroke. Cox proportional hazards regression models were used to compare recurrent stroke rates within 2 years for patients with and without CW, adjusted for age and sex. The research question was formulated prior to data collection.
Of 3439 patients with baseline CT-angiography assessed, the median age was 72 years (interquartile range, 61-80 years) and 1813 (53%) were men. Patients with CW were younger (median age, 57 [interquartile range, 46-66] years vs 66 [interquartile range, 56-77] years; P = .02 and more often women (22 of 30 [73%] vs 67 of 168 [40%]; P = .001) than patients without CW. Twenty-eight of 30 patients (93%) received medical management after the index stroke (23 with antiplatelet therapy and 5 with anticoagulant therapy). During 2 years of follow-up, 5 of 30 patients (17%) with CW had a recurrent stroke compared with 5 of 168 patients (3%) without CW (adjusted hazard ratio, 4.9; 95% CI, 1.4-18.1).
In this study, 1 of 6 patients with a symptomatic CW had a recurrent stroke within 2 years, suggesting that medical management alone may not provide sufficient protection for patients with CW.
颈动脉壁（CW）是颈内动脉球部后壁的一种架子状病变，是年轻卒中的一个被低估的原因。几项研究表明，有症状的 CW 患者再次发生卒中的风险很高，但缺乏高质量的数据。
评估有症状 CW 患者在 2 年内再次发生卒中的风险。
设计、地点和参与者：采用来自 MR CLEAN 试验（2010-2014 年）和 MR CLEAN 登记处（2014-2017 年）的比较队列研究数据。数据于 2020 年 9 月进行分析。MR CLEAN 试验和 MR CLEAN 登记处是荷兰针对大血管闭塞（LVO）卒中的血管内治疗（EVT）的全国性前瞻性多中心研究。基线数据来自 3439 例连续的前循环 LVO 卒中患者和可用的颈动脉球 CT 血管造影。两名神经放射学家重新评估 CT 血管造影图像以确定 CW 的存在或不存在，并确定了 30 例与指数性卒中同侧的 CW 患者。对于这 30 例有 CW 的合格患者，获得了 2 年内卒中复发的详细随访数据。将这 30 例与 168 例无 CW 的患者进行比较，这些患者参加了 MR CLEAN 扩展随访试验并被随机分配到 EVT 组。
主要结局是指数性卒中后 2 年内再次发生卒中。使用 Cox 比例风险回归模型比较了有和无 CW 患者在 2 年内再次发生卒中的比率，调整了年龄和性别因素。该研究问题在数据收集之前就已提出。
在评估基线 CT 血管造影的 3439 例患者中，中位年龄为 72 岁（四分位距，61-80 岁），1813 例（53%）为男性。有 CW 的患者年龄更小（中位年龄，57 岁[四分位距，46-66 岁]vs 66 岁[四分位距，56-77 岁]；P =.02），且更常见女性（22/30 [73%] vs 67/168 [40%]；P =.001）。30 例中有 28 例（93%）在指数性卒中后接受了药物治疗（23 例接受抗血小板治疗，5 例接受抗凝治疗）。在 2 年的随访期间，有 5 例（17%）有 CW 的患者发生了再次卒中，而 168 例无 CW 的患者中有 5 例（3%）发生了再次卒中（调整后的危险比，4.9；95% CI，1.4-18.1）。
在这项研究中，6 例有症状 CW 的患者中有 1 例在 2 年内再次发生卒中，这表明单独进行药物治疗可能无法为 CW 患者提供充分的保护。
