The case for aggressive intervention on symptomatic carotid web

The lead investigator behind new research from a center in Louisiana outlines how his new study— believed to be the largest single-institution analysis of symptomatic carotid web yet reported—shows that carotid duplex is “inadequate” for diagnosis, and medical management is “unacceptable.” The results, he tells Bryan Kay, reveal potential clues to possible genetic risk factors.

THE APPROPRIATE MODALITY USED FOR DIAGNOSIS, treatment method and characterization of symptomatic carotid web could be key to tackling a condition that has been shown to result in high rates of recurrent stroke when managed with medical therapy alone, according to a new study carried out by Clayton Brinster, MD, and colleagues at Ochsner Health in New Orleans.

Because there is no bulky athereosclerotic lesion in the carotid bulb in the case of the shelf-like projection redolent of carotid web, the staff surgeon tells Vascular Specialist , this pathology “is often overlooked as an etiology of acute anterior circulation stroke.”

Brinster recently presented data from a rare 52-patient series from his institution at the 2023 annual meeting (Jan. 18–21) of the Southern Association for Vascular Surgery (SAVS) in Rio Grande, Puerto Rico, that led him to conclude that medical management is “no longer an option” to treat carotid web. Over the six-year study period (2016–2022), the Ochsner researchers identified an average age of 49 years among their cohort of patients—71% of them women, two-thirds African American, and more than a third African-American women under the age of 50. Some 90% presented with stroke, Brinster told SAVS 2023. None were initially diagnosed using carotid duplex, he said. “Definitive treatment consisted of carotid endarterectomy and carotid artery stenting.”

Brinster’s subsequent conclusions were bold. “To our knowledge, this is the largest single-institution analysis of symptomatic carotid web yet reported,” he said. “Our series demonstrates that carotid duplex is inadequate for diagnosis, and that medical

THE SOUTHERN Association for Vascular Surgery (SAVS) announced its 2023–24 slate of officeholders following the conclusion of the 2023 SAVS annual business meeting.

The member-only proceedings marked the conclusion of the 2022–23 presidency of William D. Jordan Jr., MD, chief of the division of vascular surgery and endovascular therapy at Emory University in Atlanta.

David L. Cull, MD, professor of surgery at the University of South Carolina in Greenville, became SAVS president for the 2023–24 term, which took place at the end of the 2023 SAVS annual meeting.

Alan Lumsden, MD, the Walter W. Fondren III Presidential Distinguished Chair of the DeBakey Heart & Vascular Center at Houston Methodist, is the new president-elect.—Bryan Kay