Aurora Semerano1, Zakaria Mamadou2, Jean Philippe Desilles3, Candice Sabben2, Marco Bacigaluppi4, Michel Piotin3, Mickael Mazighi3, Lucas Di Meglio3, Michael Obadia5. 1. Department of Neurology and Stroke Center, Rothschild Foundation Hospital, Paris, France; Department of Neurology and Neuroimmunology Unit, San Raffaele Hospital, Milan, Italy. 2. Department of Neurology and Stroke Center, Rothschild Foundation Hospital, Paris, France. 3. Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France; Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France. 4. Department of Neurology and Neuroimmunology Unit, San Raffaele Hospital, Milan, Italy. 5. Department of Neurology and Stroke Center, Rothschild Foundation Hospital, Paris, France. Electronic address: mobadia@for.paris.
Abstract
BACKGROUND: Carotid webs are an under-recognized embolic source in patients with cryptogenic stroke. Limited resources currently exist to assist clinicians in stroke prevention for patients with symptomatic carotid webs (SCW). We aimed at analysing the clinical, radiological and procedural features of stroke patients with SCW undergoing endovascular thrombectomy (EVT), and to describe the histopathological composition of their occlusive thrombi. METHODS: In a single-center observational study on consecutive patients with ischemic stroke treated by EVT, carotid web was defined symptomatic when it was ipsilateral to the ischemic lesion in a patient classified with stroke of otherwise undetermined etiology. Clinical, radiological and procedural data of patients with SCW were evaluated. Histopathological examination of the retrieved thrombi was performed. RESULTS: Out of 1430 patients with large vessel occlusion stroke treated by EVT, 11(0.7%) were found to have a SCW. Patients with SCW had a median age of 47 years old (IQR 38-50), they were prevalently women (55%), mostly of African ethnicity (91%). Each of the 11 patients achieved successful angiographic reperfusion (mTICI 2b-3) after EVT. For secondary prevention, elective endovascular carotid stenting was performed in 5 (55%) patients, while 1 (9%) was treated by surgical endoarterectomy. Histological analysis of the retrieved thrombi performed in 4 patients showed a mixed composition with variable red blood cell content. CONCLUSIONS: EVT is feasible in large vessel occlusion stroke related to SCW. Procedures of carotid revascularization appear to be feasible therapeutic options for secondary prevention. The histopathological analysis of cerebral thrombi may provide new insights on stroke pathogenesis in patients with SCW.
BACKGROUND: Carotid webs are an under-recognized embolic source in patients with cryptogenic stroke. Limited resources currently exist to assist clinicians in stroke prevention for patients with symptomatic carotid webs (SCW). We aimed at analysing the clinical, radiological and procedural features of strokepatients with SCW undergoing endovascular thrombectomy (EVT), and to describe the histopathological composition of their occlusive thrombi. METHODS: In a single-center observational study on consecutive patients with ischemic stroke treated by EVT, carotid web was defined symptomatic when it was ipsilateral to the ischemic lesion in a patient classified with stroke of otherwise undetermined etiology. Clinical, radiological and procedural data of patients with SCW were evaluated. Histopathological examination of the retrieved thrombi was performed. RESULTS: Out of 1430 patients with large vessel occlusion stroke treated by EVT, 11(0.7%) were found to have a SCW. Patients with SCW had a median age of 47 years old (IQR 38-50), they were prevalently women (55%), mostly of African ethnicity (91%). Each of the 11 patients achieved successful angiographic reperfusion (mTICI 2b-3) after EVT. For secondary prevention, elective endovascular carotid stenting was performed in 5 (55%) patients, while 1 (9%) was treated by surgical endoarterectomy. Histological analysis of the retrieved thrombi performed in 4 patients showed a mixed composition with variable red blood cell content. CONCLUSIONS:EVT is feasible in large vessel occlusion stroke related to SCW. Procedures of carotid revascularization appear to be feasible therapeutic options for secondary prevention. The histopathological analysis of cerebral thrombi may provide new insights on stroke pathogenesis in patients with SCW.
Authors: Oskar Aspegren; Senna Staessens; Sarah Vandelanotte; Linda Desender; Charlotte Cordonnier; Laurent Puy; Nicolas Bricout; Simon F De Meyer; Tommy Andersson; Fabian Arnberg Journal: Front Neurol Date: 2022-05-17 Impact factor: 4.086