Abstract MP46: Internal Carotid Artery Web and Acute Ischemic Stroke - A Systematic Review and Meta-Analysis

Introduction:The carotid web is a compelling potential mechanism of embolic ischemic stroke. In this study, we perform a systematic review and meta-analysis to determine the prevalence of ipsilesional carotid webs in patients with acute ischemic stroke.Methods:We performed a systematic review of prospective and retrospective observational studies enrolling consecutive patients with acute ischemic stroke. We included only studies in which high quality imaging of the cervical vessels was performed and in which the presence or absence of carotid web was adjudicated based on established criteria. The prevalence of carotid web was calculated in each study and pooled prevalence calculated via a random effects model. We also calculated relative risks of carotid web ipsilateral versus contralateral to stroke in the same pool of patients and performed sensitivity analyses including patients with cryptogenic stroke, patients less than 60 and patients with cryptogenic stroke <60.Results:A systematic review yielded 3,814 patients from 11 studies of whom 1,127 had cryptogenic stroke. We identified 4 studies in which we could derive data on patients <60 with cryptogenic stroke, a total of 332 patients. The relative risk of carotid web ipsilateral versus contralateral to ischemic stroke was 2.6 (95%: 1.6-4.3, p<0.01) in all patients with acute ischemic stroke and 3.0 (95% CI: 1.6-5.8, p<0.01) in patient less than 60 with cryptogenic stroke (Figure A-C). The pooled prevalence of ipsilateral carotid web in patients <60 with cryptogenic stroke was 13% (95% CI: 7%-22%; I2= 66.1%) (Figure D).Discussion:Carotid webs are more common in young patients with ESUS than in other stroke subtypes. Future studies concerning the diagnosis and secondary prevention of stroke associated with carotid web should focus on this population.