Unité Neurovasculaire, Département de Neurologie, Hôpital Gui de Chauliac, Montpellier, France.
Département de Neuroradiologie diagnostique et thérapeutique, Hôpital Gui de Chauliac, Montpellier, France.
J Neurol Sci. 2021 Aug 15;427:117513. doi: 10.1016/j.jns.2021.117513. Epub 2021 May 28.
Carotid webs (CaW) may be an under-recognized cause of anterior circulation cryptogenic ischemic stroke (ACIS). Prevalence is still unknown in European patients with ACIS.
To evaluate the prevalence of CaW in ACIS and describe patients with CaW phenotype in a cohort of patients from a French stroke center.
We conducted a retrospective monocentric cohort study from 01/01/2015 to 31/12/2019 (Montpellier University Hospital, France), in consecutive anterior ischemic stroke (AIS) patients ≤65 years old from a prospective stroke database. Using ASCOD phenotyping, ACIS patients were selected and cervical CTA were reviewed to find CaW.
Among 1053 consecutive AIS patients, 266 ACIS patients with CTA were included. Among patients included (mean age 50, women 58%), CaW was in the ipsilateral carotid (iCaW) in 21 patients: 7.9% (95%CI [4.6-11.1]), (mean age 51, 11 women, 16 Caucasian). iCaW were uncovered during study review of CTA in 6/21 (29%) patients. Comparison between patients with iCaW and those without iCaW showed no differences except that of a higher rate of intracranial large vessel occlusion (LVO) (62.4 vs 37.6%; p = 0.03). Patients with iCaW under conservative medical therapy had an annualized stroke recurrence rate (SRR) of 11.4% (95%CI [8.4-15.1].
iCaW was identified as a source of stroke in about 8% of a French population ≤65 years with ACIS. iCaW was associated with a higher rate of LVO and a high SRR under conservative medical therapy.
颈动脉壁（CaW）可能是前循环隐源性缺血性卒中（ACIS）被低估的原因。欧洲 ACIS 患者的患病率尚不清楚。
评估 CaW 在 ACIS 中的患病率，并描述法国卒中中心患者队列中具有 CaW 表型的患者。
我们进行了一项回顾性单中心队列研究，纳入了 2015 年 1 月 1 日至 2019 年 12 月 31 日期间来自法国蒙彼利埃大学医院前瞻性卒中数据库的连续≤65 岁前循环缺血性卒中（AIS）患者。使用 ASCOD 表型学，选择 ACIS 患者并回顾颈 CTA 以寻找 CaW。
在 1053 例连续 AIS 患者中，纳入了 266 例有 CTA 的 ACIS 患者。在纳入的患者中（平均年龄 50 岁，女性 58%），21 例存在同侧颈动脉 CaW（iCaW）：7.9%（95%CI [4.6-11.1]），（平均年龄 51 岁，11 名女性，16 名白种人）。在 6/21（29%）患者的 CTA 研究回顾中未发现 iCaW。与无 iCaW 的患者相比，iCaW 患者除颅内大血管闭塞（LVO）发生率较高（62.4% vs 37.6%；p=0.03）外，无其他差异。接受保守药物治疗的 iCaW 患者的年卒中复发率（SRR）为 11.4%（95%CI [8.4-15.1]）。
iCaW 被认为是法国≤65 岁人群 ACIS 的一种卒中来源，约占 8%。iCaW 与 LVO 发生率较高和保守药物治疗下的高 SRR 相关。
