Supplementary Material for: Multicenter Experience with Stenting for Symptomatic Carotid Web

Background: A carotid web (CaW) is a shelf-like lesion in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. CaW has been associated with recurrent strokes and conventionally treated with surgical excision. We report a multicenter experience of stenting in patients with symptomatic CaWs. Methods: Retrospective review of consecutive patients admitted to 5 comprehensive stroke centers who were identified to have a symptomatic CaW and treated with carotid stenting. A symptomatic CaW was defined by the presence of a shelf-like/linear, smooth filling defect in the posterior aspect of the carotid bulb diagnosed by neck CT angiography (CTA) and confirmed with conventional angiography in patients with negative stroke workup. Results: Twenty-four patients with stented symptomatic CaW were identified (stroke in 83% and transient ischemic attack in 17%). Their median age was 47 years (IQR 41–61), 14 (58%) were female, and were 17 (71%) black. The degree of stenosis by NASCET was 0% (range 0–11). All patients were placed on dual antiplatelets and stented at a median of 9 days (IQR 4–35) after the last event. Closed-cell stents were used in 18 (75%) of the cases. No periprocedural events occurred with the exception of 2 cases of asymptomatic hypotension/bradycardia. Clinical follow-up after stent placement occurred for a median of 12 months (IQR 3–19) with no new cerebrovascular events noted. Functional independence at 90 days was achieved in 22 (91%) patients. Follow-up vascular imaging (ultrasound n = 18/CTA n = 5) was performed at a median of 10 months (IQR 3–18) and revealed no stenosis. Conclusions: Stenting for symptomatic CaW appears to be a safe and effective alternative to surgical resection. Further studies are warranted.背景：颈动脉蹼（carotid web, CaW）是颈内动脉球部后壁的棚架样病变，属于纤维肌发育不良的内膜亚型。颈动脉蹼已被证实与复发性卒中相关，传统治疗方式为手术切除。本研究报道了多中心对有症状颈动脉蹼患者实施支架置入的临床经验。 方法：对纳入5家综合卒中中心的连续患者进行回顾性审查，这些患者均被确诊为有症状颈动脉蹼，并接受了颈动脉支架置入治疗。有症状颈动脉蹼的定义为：经颈部CT血管造影（CT angiography, CTA）诊断为颈动脉球部后壁存在棚架样/线状光滑充盈缺损，且在卒中排查结果为阴性的患者中经常规血管造影证实。 结果：共纳入24例接受支架置入的有症状颈动脉蹼患者，其中83%发生卒中，17%出现短暂性脑缺血发作（transient ischemic attack, TIA）。患者中位年龄为47岁（四分位间距41~61岁），14例（58%）为女性，17例（71%）为黑人。按北美症状性颈动脉内膜切除术试验（North American Symptomatic Carotid Endarterectomy Trial, NASCET）标准评估的狭窄程度为0%（范围0~11%）。所有患者均接受双联抗血小板治疗，并在末次卒中事件发生后中位9天（四分位间距4~35天）实施支架置入术。其中18例（75%）使用了闭环支架。围手术期未发生严重不良事件，仅2例出现无症状性低血压/心动过缓。支架置入后临床随访中位时长为12个月（四分位间距3~19个月），未观察到新发脑血管事件。90天时22例（91%）患者实现功能独立。随访血管影像学检查（超声检查18例、CTA检查5例）的中位时长为10个月（四分位间距3~18个月），未发现狭窄病变。 结论：对于有症状颈动脉蹼患者，支架置入术似乎是手术切除之外安全且有效的替代方案，尚需开展进一步相关研究。