A systematic literature review of patients with Carotid web and acute ischemic stroke

Andrew J. Zhang, Parth Dhruv, Philip Choi, Caitlin Bakker, Jonathan Koffel, David Anderson, Jae H Kim, Bharathi D Jagadeesan, Bijoy K. Menon, Christopher D Streib

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Background and Purpose-Carotid web (CW) is a rare form of focal fibromuscular dysplasia defined as an abnormal shelflike projection of intimal fibrous tissue into the carotid bulb. It is theorized that CW leads to ischemic stroke secondary to blood flow stasis and subsequent embolization. The natural history and optimal management of CW are unclear. To address this knowledge gap, we performed a systematic literature review (SLR) of CW. Methods-Our librarians performed a SLR for CW and related terminology. Patient-level demographics, stroke risk factors, neuroimaging findings, stroke recurrence or stroke free-duration, and treatment modality were extracted. We used descriptive statistics to characterize our results. When specific patient-level metrics were not reported, the denominators for reporting percentage calculations were adjusted accordingly. Results-Our literature search produced 1150 articles. Thirty-seven articles including 158 patients (median age 46 years [range 16-85], 68% women, 76% symptomatic) met entry criteria and were included in our SLR. Of the symptomatic CW patients: 57% did not have stroke risk factors, 56% who received medical therapy had recurrent stroke (median 12 months, range 0-97), and 72% were ultimately treated with carotid revascularization (50% carotid stenting, 50% carotid endarterectomy). There were no periprocedural complications or recurrent strokes in carotid revascularization patients. Conclusions-CW leads to ischemic stroke in younger patients without conventional stroke risk factors. We found a high stroke recurrence rate in medically managed symptomatic CW patients, whereas carotid revascularization effectively prevented recurrent stroke. Our findings should be interpreted with caution because of risk of publication and reporting bias.

Original languageEnglish (US)
Pages (from-to)2872-2876
Number of pages5
JournalStroke
Volume49
Issue number12
DOIs
StatePublished - Jan 1 2018

Fingerprint

Stroke
Fibromuscular Dysplasia
Tunica Intima
Librarians
Recurrence
Publication Bias
Carotid Endarterectomy
Natural History
Terminology
Neuroimaging
Demography
Therapeutics

Keywords

  • Brain ischemia
  • Carotid arteries
  • Fibromuscular dysplasia
  • Risk factors
  • Stroke

Cite this

A systematic literature review of patients with Carotid web and acute ischemic stroke. / Zhang, Andrew J.; Dhruv, Parth; Choi, Philip; Bakker, Caitlin; Koffel, Jonathan; Anderson, David; Kim, Jae H; Jagadeesan, Bharathi D; Menon, Bijoy K.; Streib, Christopher D.

In: Stroke, Vol. 49, No. 12, 01.01.2018, p. 2872-2876.

Research output: Contribution to journalReview article

Zhang, Andrew J. ; Dhruv, Parth ; Choi, Philip ; Bakker, Caitlin ; Koffel, Jonathan ; Anderson, David ; Kim, Jae H ; Jagadeesan, Bharathi D ; Menon, Bijoy K. ; Streib, Christopher D. / A systematic literature review of patients with Carotid web and acute ischemic stroke. In: Stroke. 2018 ; Vol. 49, No. 12. pp. 2872-2876.
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abstract = "Background and Purpose-Carotid web (CW) is a rare form of focal fibromuscular dysplasia defined as an abnormal shelflike projection of intimal fibrous tissue into the carotid bulb. It is theorized that CW leads to ischemic stroke secondary to blood flow stasis and subsequent embolization. The natural history and optimal management of CW are unclear. To address this knowledge gap, we performed a systematic literature review (SLR) of CW. Methods-Our librarians performed a SLR for CW and related terminology. Patient-level demographics, stroke risk factors, neuroimaging findings, stroke recurrence or stroke free-duration, and treatment modality were extracted. We used descriptive statistics to characterize our results. When specific patient-level metrics were not reported, the denominators for reporting percentage calculations were adjusted accordingly. Results-Our literature search produced 1150 articles. Thirty-seven articles including 158 patients (median age 46 years [range 16-85], 68{\%} women, 76{\%} symptomatic) met entry criteria and were included in our SLR. Of the symptomatic CW patients: 57{\%} did not have stroke risk factors, 56{\%} who received medical therapy had recurrent stroke (median 12 months, range 0-97), and 72{\%} were ultimately treated with carotid revascularization (50{\%} carotid stenting, 50{\%} carotid endarterectomy). There were no periprocedural complications or recurrent strokes in carotid revascularization patients. Conclusions-CW leads to ischemic stroke in younger patients without conventional stroke risk factors. We found a high stroke recurrence rate in medically managed symptomatic CW patients, whereas carotid revascularization effectively prevented recurrent stroke. Our findings should be interpreted with caution because of risk of publication and reporting bias.",
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T1 - A systematic literature review of patients with Carotid web and acute ischemic stroke

AU - Zhang, Andrew J.

AU - Dhruv, Parth

AU - Choi, Philip

AU - Bakker, Caitlin

AU - Koffel, Jonathan

AU - Anderson, David

AU - Kim, Jae H

AU - Jagadeesan, Bharathi D

AU - Menon, Bijoy K.

AU - Streib, Christopher D

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background and Purpose-Carotid web (CW) is a rare form of focal fibromuscular dysplasia defined as an abnormal shelflike projection of intimal fibrous tissue into the carotid bulb. It is theorized that CW leads to ischemic stroke secondary to blood flow stasis and subsequent embolization. The natural history and optimal management of CW are unclear. To address this knowledge gap, we performed a systematic literature review (SLR) of CW. Methods-Our librarians performed a SLR for CW and related terminology. Patient-level demographics, stroke risk factors, neuroimaging findings, stroke recurrence or stroke free-duration, and treatment modality were extracted. We used descriptive statistics to characterize our results. When specific patient-level metrics were not reported, the denominators for reporting percentage calculations were adjusted accordingly. Results-Our literature search produced 1150 articles. Thirty-seven articles including 158 patients (median age 46 years [range 16-85], 68% women, 76% symptomatic) met entry criteria and were included in our SLR. Of the symptomatic CW patients: 57% did not have stroke risk factors, 56% who received medical therapy had recurrent stroke (median 12 months, range 0-97), and 72% were ultimately treated with carotid revascularization (50% carotid stenting, 50% carotid endarterectomy). There were no periprocedural complications or recurrent strokes in carotid revascularization patients. Conclusions-CW leads to ischemic stroke in younger patients without conventional stroke risk factors. We found a high stroke recurrence rate in medically managed symptomatic CW patients, whereas carotid revascularization effectively prevented recurrent stroke. Our findings should be interpreted with caution because of risk of publication and reporting bias.

AB - Background and Purpose-Carotid web (CW) is a rare form of focal fibromuscular dysplasia defined as an abnormal shelflike projection of intimal fibrous tissue into the carotid bulb. It is theorized that CW leads to ischemic stroke secondary to blood flow stasis and subsequent embolization. The natural history and optimal management of CW are unclear. To address this knowledge gap, we performed a systematic literature review (SLR) of CW. Methods-Our librarians performed a SLR for CW and related terminology. Patient-level demographics, stroke risk factors, neuroimaging findings, stroke recurrence or stroke free-duration, and treatment modality were extracted. We used descriptive statistics to characterize our results. When specific patient-level metrics were not reported, the denominators for reporting percentage calculations were adjusted accordingly. Results-Our literature search produced 1150 articles. Thirty-seven articles including 158 patients (median age 46 years [range 16-85], 68% women, 76% symptomatic) met entry criteria and were included in our SLR. Of the symptomatic CW patients: 57% did not have stroke risk factors, 56% who received medical therapy had recurrent stroke (median 12 months, range 0-97), and 72% were ultimately treated with carotid revascularization (50% carotid stenting, 50% carotid endarterectomy). There were no periprocedural complications or recurrent strokes in carotid revascularization patients. Conclusions-CW leads to ischemic stroke in younger patients without conventional stroke risk factors. We found a high stroke recurrence rate in medically managed symptomatic CW patients, whereas carotid revascularization effectively prevented recurrent stroke. Our findings should be interpreted with caution because of risk of publication and reporting bias.

KW - Brain ischemia

KW - Carotid arteries

KW - Fibromuscular dysplasia

KW - Risk factors

KW - Stroke

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U2 - 10.1161/STROKEAHA.118.021907

DO - 10.1161/STROKEAHA.118.021907

M3 - Review article

VL - 49

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EP - 2876

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 12

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