Carotid Webs in Pediatric Acute Ischemic Stroke

Introduction: Carotid web is a radiographic entity located in the posterior aspect of the origin of the internal carotid arteries, considered to be a pathologic equivalent to intimal fibromuscular dysplasia, and has been implicated in acute ischemic strokes. The mechanism underlying its development is unknown and it remains unclear if this lesion is congenital or acquired. The aim of our study was to determine the frequency of carotid webs in a pediatric population with acute ischemic stroke (AIS). Methods: A retrospective review of neck CTA, MRA, or DSA images in a pediatric population with acute ischemic stroke was performed to determine the occurrence of carotid webs. Two fellowship-trained neurointerventionists performed independent vascular imaging review. Results: We identified forty-seven cases of childhood acute ischemic stroke (55% male; median age, 9 years). Congenital heart disease, sickle cell disease, infection, and recent head/neck trauma were the most common risk factors. Eight of the ischemic stroke cases were located in multiple vascular territories. Neck arterial imaging was undertaken in twenty-four patients. No carotid webs were detected in the studied pediatric stroke population. (The correlation coefficient for the determination of webs was Kappa = 1.00; p < 0.001). Conclusion: This study failed to find evidence that carotid webs are congenital. More studies are needed for a better understanding of carotid web origin, natural evolution, and the potential implications for treatment.