Bounajem Michael T, Liang Allison, Trang Annie, El Baba Bachar, Bielinski Tyler M, Sangwon Karl, Zhang Yuchong, Wiggan Daniel, Grin Eric, Gajjar Avi, Pasarikovski Christopher R, Yang Victor Xd, Agid Ronit, Levitt Michael, Anderson Matthew, Meyer Raymond M, Cherian Jacob, Howard Brian, Hendrix Philipp, Abecassis Isaac Josh, Srinivasan Visish, El Naamani Kareem, Gooch M Reid, Nossek Erez, Grandhi Ramesh
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
University of Maryland School of Medicine, Baltimore, MD, USA.
Interv Neuroradiol. 2025 Aug 8:15910199251365529. doi: 10.1177/15910199251365529.
ObjectiveCarotid web can serve as a nidus for clot formation and subsequent thromboembolic stroke. Although treatment historically involved antiplatelet therapy, recent evidence demonstrates notably elevated recurrent stroke rates despite best medical therapy. We examined the safety and efficacy of carotid artery stenting (CAS), which involves placing a coil in the artery, and carotid endarterectomy (CEA), a surgery to remove the clot, for treatment of symptomatic carotid web.MethodsA multi-institutional retrospective registry including adult patients with carotid web with history of ipsilateral acute ischemic stroke or transient ischemic attack (TIA) treated with either carotid artery stenting or endarterectomy was reviewed. Patient demographics, comorbidities, clinical presentation, treatment methodology, and outcomes at follow up were collected.ResultsAmong the 71 included patients (mean age 52.4 years, 44 (62.4%) female), 23 (32.4%) underwent CEA, and 48 (67.6%) underwent CAS. The most common presenting symptoms were hemibody numbness/weakness, aphasia, and gaze deviation. On average, patients had experienced 1.12 ± 0.7 strokes or TIAs before intervention, with a mean delay of 115 ± 224 days between initial stroke/TIA and intervention. The median preintervention modified Rankin Scale (mRS) score was 2. Perioperatively, one patient (1.41%) experienced stroke and none experienced myocardial infarction. During mean 14.8 (±29.2)-month follow up, one patient experienced asymptomatic recurrent stroke (1.41%). Median mRS at follow up was 1, and carotid artery stenting and endarterectomy demonstrated similar rates of postoperative complication and recurrent stroke rates.ConclusionOur results suggest that endarterectomy and stenting are safe and efficacious for minimizing subsequent stroke risk in patients who have experienced stroke or TIA from carotid webbing, warranting further studies to determine the optimal timing and method of treatment.
目的
颈动脉蹼可作为血栓形成及随后血栓栓塞性卒中的病灶。尽管以往的治疗方法包括抗血小板治疗，但近期证据表明，即便采用最佳药物治疗，复发性卒中的发生率仍显著升高。我们研究了颈动脉支架置入术（CAS，即将线圈置于动脉内）及颈动脉内膜切除术（CEA，一种清除血栓的手术）治疗有症状颈动脉蹼的安全性和有效性。
方法
回顾一项多机构回顾性登记研究，纳入患有颈动脉蹼且有同侧急性缺血性卒中或短暂性脑缺血发作（TIA）病史并接受了颈动脉支架置入术或内膜切除术的成年患者。收集患者的人口统计学信息、合并症、临床表现、治疗方法及随访结果。
结果
在纳入的71例患者（平均年龄52.4岁，44例（62.4%）为女性）中，23例（32.4%）接受了CEA，48例（67.6%）接受了CAS。最常见的症状表现为半身麻木/无力、失语及凝视偏斜。平均而言，患者在干预前经历了1.12±0.7次卒中或TIA，首次卒中/TIA与干预之间的平均间隔为115±224天。干预前改良Rankin量表（mRS）评分的中位数为2。围手术期，1例患者（1.41%）发生卒中，无患者发生心肌梗死。在平均14.8（±29.2）个月的随访期间，1例患者发生无症状复发性卒中（1.41%）。随访时mRS的中位数为1，颈动脉支架置入术和内膜切除术的术后并发症发生率及复发性卒中发生率相似。
结论
我们的结果表明，内膜切除术和支架置入术对于降低因颈动脉蹼发生过卒中或TIA的患者后续卒中风险是安全有效的，需要进一步研究以确定最佳治疗时机和方法。
