title: Carotid Webs and Recurrent Ischemic Strokes in the Era of CT Angiography.
abstract: OBJECTIVE
  Carotid webs may cause recurrent ischemic stroke. We describe the prevalence, demographics, clinical presentation, imaging features, histopathology, and stroke risk associated with this under-recognized lesion.
  
  
  METHODS
  A carotid web was defined on CTA as a thin intraluminal filling defect along the posterior wall of the carotid bulb just beyond the carotid bifurcation on oblique sagittal section CTA that was seen as a septum on axial CTA. Using a prospective case series from April 2013 to April 2014, we describe the demographics, spectrum of imaging features on CTA, and histopathology of these carotid webs. From a retrospective analysis of patients at our center from May 2012 to April 2013 who had a baseline head and neck CTA followed by a brain MR imaging within 1-2 days of the CTA, we determine the period prevalence of carotid webs and the prevalence of ipsilateral stroke on imaging.
  
  
  RESULTS
  In the prospective series, the mean age was 50 years (range, 41-55 years); 5/7 patients were women. Recurrent stroke was seen in 5/7 (71.4%) patients with the carotid web; time to recurrence ranged from 1 to 97 months. Histopathology suggested a high probability of fibromuscular dysplasia. In the retrospective series, carotid webs were seen in 7/576 patients for a hospital-based-period prevalence of 1.2% (95% CI, 0.4%-2.5%). Two of these 7 patients had acute stroke in the vascular territory of the carotid web.
  
  
  CONCLUSIONS
  A carotid web may contribute to recurrent ischemic stroke in patients with no other determined stroke mechanism. Intimal variant fibromuscular dysplasia is the pathologic diagnosis in most cases. The prevalence of carotid web is low, while the optimal management strategy remains unknown.
authors.affiliation: From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.).
authors.forename: P M C
authors.initials: PM
authors.lastname: Choi
authors.affiliation: From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.).
authors.forename: D
authors.initials: D
authors.lastname: Singh
authors.affiliation: From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.).
authors.forename: A
authors.initials: A
authors.lastname: Trivedi
authors.affiliation: From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.).
authors.forename: E
authors.identifier: http://orcid.org/0000-0003-0222-3884
authors.initials: E
authors.lastname: Qazi
authors.affiliation: Departments of Pathology and Laboratory Medicine (D.G.).
authors.forename: D
authors.initials: D
authors.lastname: George
authors.affiliation: From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.) Radiology (J.W., A.M.D., M.G., M.D.H., B.K.M.).
authors.forename: J
authors.initials: J
authors.lastname: Wong
authors.affiliation: From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.) Radiology (J.W., A.M.D., M.G., M.D.H., B.K.M.) Hotchkiss Brain Institute (A.M.D., M.G., M.D.H., B.K.M.), Calgary, Alberta, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.) Radiology (J.W., A.M.D., M.G., M.D.H., B.K.M.) Hotchkiss Brain Institute (A.M.D., M.G., M.D.H., B.K.M.), Calgary, Alberta, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Goyal
authors.affiliation: From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.) Radiology (J.W., A.M.D., M.G., M.D.H., B.K.M.) Medicine and Community Health Science (M.D.H.), University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute (A.M.D., M.G., M.D.H., B.K.M.), Calgary, Alberta, Canada.
authors.forename: M D
authors.identifier: http://orcid.org/0000-0002-6269-1543
authors.initials: MD
authors.lastname: Hill
authors.affiliation: From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.) Radiology (J.W., A.M.D., M.G., M.D.H., B.K.M.) Hotchkiss Brain Institute (A.M.D., M.G., M.D.H., B.K.M.), Calgary, Alberta, Canada. Bijoy.Menon@Albertahealthservices.ca.
authors.forename: B K
authors.initials: BK
authors.lastname: Menon
mesh_terms: D000328:Adult; D002340:Carotid Artery Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000473:pathology; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods