Abstract TP129: Comparative Risk of Recurrent Stroke in Stroke-Causing and Asymptomatic Carotid Webs

Background: A carotid web is a shelf-like projection of intimal tissue in the carotid bulb that can cause stroke, particularly in younger patients. The risk of recurrent events after web-associated stroke/TIA and the optimal prevention strategy remain uncertain with limited longitudinal data available. Methods: We conducted a two-center retrospective cohort study of patients with confirmed carotid webs on neck CT angiography between 2021–2024. Webs were considered symptomatic if the index ischemic event was only in the ipsilateral carotid distribution and no other etiology was present, and asymptomatic if the web was incidentally identified, there were infarcts in other distributions, or there were other stroke etiologies present. The primary outcome was recurrent ischemic stroke or TIA. Event rates were calculated per 100 person-years. Cox proportional hazards models adjusted for vascular risk factors estimated the hazard of recurrence. Results: Among 214 patients with confirmed webs (24 symptomatic, 190 asymptomatic), baseline demographics and vascular risk profiles were similar between groups. Over a median follow-up of 14.4 months (IQR 3.7–26.1), ischemic events occurred in 3/24 patients with symptomatic web (12.5%) and 12/190 patients with asymptomatic web (6.3%). The corresponding event rates were 6.8 per 100 person-years (95% CI 2.2–21.1) for symptomatic webs and 4.5 per 100 person-years (95% CI 2.6–7.9) for asymptomatic webs. Adjusted analysis demonstrated a non-significant twofold higher risk of recurrence with symptomatic webs (HR 2.04, 95% CI 0.56–7.34) compared to asymptomatic webs. Patients undergoing carotid endarterectomy or stenting (n=5) had no recurrent events during 10.0 person-years of follow-up, compared with 9.4% recurrence in medically managed patients with symptomatic webs (event rate 6 per 100 person-years, 95% CI 1.9–18.7). Conclusions: In this two-center cohort, patients with symptomatic carotid webs had a numerically higher risk of recurrent ischemic events compared with those with asymptomatic webs, though statistical significance was not reached. The absence of recurrences after carotid intervention highlights the need for prospective studies to refine risk stratification and management.