Ipsilateral internal carotid artery web and acute ischemic stroke: A cohort study, systematic review and meta-analysis.
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2021-01
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Abstract
Introduction
The carotid web is a compelling potential mechanism of embolic ischemic stroke. In this study, we aim to determine the prevalence of ipsilateral carotid web in a cohort of ischemic stroke patients and to perform a systematic review and meta-analysis of similar cohorts.Patients & methods
We performed a retrospective, observational, cohort study of acute ischemic stroke patients admitted to a comprehensive stroke center from June 2012 to September 2017. Carotid web was defined on computed tomography angiography (CTA) as a thin shelf of non-calcified tissue immediately distal to the carotid bifurcation. We described the prevalence of carotid artery webs in our cohort, then performed a systematic review and meta-analysis of similar cohorts in the published literature.Results
We identified 1,435 potentially eligible patients of whom 879 met criteria for inclusion in our analysis. An ipsilateral carotid web was detected in 4 out of 879 (0.45%) patients, of which 4/4 (1.6%) were in 244 patients with cryptogenic stroke and 3/4 were in 66 (4.5%) patients <60 years old with cryptogenic stroke. Our systematic review yielded 3,192 patients. On meta-analysis, the pooled prevalence of ipsilateral carotid web in cryptogenic stroke patients <60 was 13% (95% CI: 7%-22%; I2 = 66.1%). The relative risk (RR) of ipsilateral versus contralateral carotid web in all patients was 2.5 (95% CI 1.5-4.2, p = 0.0009) whereas in patients less than 60 with cryptogenic stroke it was 3.0 (95% CI 1.6-5.8, p = 0.0011).Discussion
Carotid webs are more common in young patients with cryptogenic stroke than in other stroke subtypes. Future studies concerning the diagnosis and secondary prevention of stroke associated with carotid web should focus on this population.Type
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Mac Grory, Brian, Erez Nossek, Michael E Reznik, Matthew Schrag, Mahesh Jayaraman, Ryan McTaggart, Adam de Havenon, Shadi Yaghi, et al. (2021). Ipsilateral internal carotid artery web and acute ischemic stroke: A cohort study, systematic review and meta-analysis. PloS one, 16(9). p. e0257697. 10.1371/journal.pone.0257697 Retrieved from https://hdl.handle.net/10161/34020.
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Brian C. Mac Grory
Dr. Brian Mac Grory, MB BCh BAO, MHSc, MRCP, FAHA, FANA is an Associate Professor of Neurology & Ophthalmology at the Duke University School of Medicine and a Staff Neurologist at Duke University Medical Center. He received his medical degree from University College Dublin in Dublin, Ireland in 2011. After an internship at St. Vincent's University Hospital, Dublin, he completed a neurology residency and vascular neurology fellowship at the Yale School of Medicine/Yale-New Haven Hospital in New Haven, Connecticut. Upon completion of his training, he served for 3 years on the faculty of Brown University/Rhode Island Hospital before being recruited to Duke University in 2020.
His clinical practice encompasses both vascular and general neurology in the emergency, inpatient, outpatient, and telemedicine settings. He has a particular clinical interest in central retinal artery occlusion (CRAO or "eye stroke") and has developed a center of excellence for the treatment of this condition at Duke. He led the development of the first ever American Heart Association (AHA) scientific consensus statement on the management of CRAO which was endorsed by six professional medical societies in the United States representing neurology, neurosurgery, cardiology, ophthalmology, neuro-ophthalmology, and optometry.
Dr. Mac Grory has published over 150 peer-reviewed scientific articles appearing in JAMA, British Medical Journal, Circulation, Stroke, Annals of Neurology, JAMA Neurology, and Neurology. His research on retinal vascular disease is funded by the National Institutes of Health/National Heart, Lung, and Blood Institute (K23 HL161426), the AHA (23MRFSCD1077188 & 25GLP1450119), and the Duke Office of Physician-Scientist Development (FRCS #2835124). Additionally, he serves as Clinical Lead for the Get With The Guidelines-Stroke Data Analytic Program at the Duke Clinical Research Institute (DCRI) and Associate Program Director for the vascular neurology fellowship program at Duke. His research has been recognized with the Stroke Progress and Innovation Award, Stroke Care in Emergency Medicine Award, and Early Career Investigator Award from the AHA/American Stroke Association and the Young Physician-Scientist Award from the American Society for Clinical Investigation. He is a member of the AHA's Stroke Systems of Care Advisory Group, the Stroke Emergency Neurovascular Care Committee, and the Royal College of Physicians of the United Kingdom (MRCP(UK)).
Wuwei Feng
Wayne Feng is the Chief of Division of Stroke & Vascular Neurology, Medical Director of Duke Comprehensive Stroke Center, and Tenured Profess of Neurology and Biomedical Engineering at Duke University School of Medicine. Dr. Feng is a board-certified vascular neurologist as well as a physician scientist. His research portfolios include developing imaging biomarker for post-stroke motor outcomes prediction, and use of non-invasive brain stimulation tools, such as, transcranial direct current stimulation (tDCS), vagus nerve stimulation, low intensity focused ultrasound and transcranial light stimulation to enhance post-stroke recovery. His research has been actively funded by the National Institute of Health (NIH), the American Heart Association/American Stroke Association (AHA/ASA) and other various sources. He is currently leading an NIH funded 8.9 million U01 12-center, phase II study called TRANSPORT 2 (TRANScranial direct current stimulation for POst-stroke motor Recovery – a phase II sTudy) – on the NINDS funded stroke trial network.
Dr. Feng has published over 150 peer reviewed manuscripts (H index of 36), including two manuscripts featured on the cover page of brain stimulation journal, and one manuscript featured on Journal of Neuroscience. He co-edited - “Cerebral Venous System in Acute and Chronic Brain Injuries” book. He served as the associate editor for Translational Stroke Research from 2019 to 2021(IF=7.0). Dr. Feng received several prestigious awards for his research work in stroke and stroke recovery including the FIRST “Rehabilitation Award” from the American Heart Association/American Stroke Association in 2015, “Franz Gerstenbrand Award” from World Federation of Neurorehabilitation (WFNR) in 2016, Arthur Guyton New Investigator Award, Consortium for Southeastern Hypertension Control (COSEHC) in 2016 and “Clinical Investigator Award” from the Society of Chinese American Physician Entrepreneur (SCAPE). Currently, he is the Section Chair of Neural Repair & Rehabilitation, the American Academy of Neurology. He leads the global mentoring program for the WFNR.
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