ABSTRACT NUMBER: ESOC2026A2066 PREVALENCE AND CLINICAL CHARACTERISTICS OF CAROTID WEBS IN LARGE VESSEL OCCLUSION STROKE: A POOLED ANALYSIS OF MR CLEAN TRIALS AND REGISTRY

Abstract Background and aims Carotid webs (CaWebs) are an uncommon and still underrecognized risk factor for large vessel occlusion (LVO) stroke. This pooled analysis builds on previous findings (Guglielmi et al.; DOI:10.1001/jamaneurol.2021.1101) and aims to refine estimates of the prevalence, risk factors, and early recurrent stroke risk associated with CaWebs. Methods We pooled patient data from all five MR CLEAN studies. CaWebs were reported by an expert panel on baseline computed tomography angiography (CTA) images in patients with LVO stroke. Symptomatic CaWebs were defined as ipsilateral to the index stroke. We estimated prevalence, risk factors with logistic regression, and 3-month recurrent ischemic stroke risk with Cox regression. Results Among 5,303 LVO patients, 64 (1.2%; 95% CI 0.9-1.5%) had a CaWeb. Prevalence in those < 50 years old versus those ≥50 was 4.0% versus 1.0% (P < 0.001). Patients with CaWeb were more often women (67% vs 48%, P < 0.01), and less often hypertensive (34% vs 55%, P < 0.01) or diabetic (6% vs 17%, P = 0.03). Women (adjusted OR 2.2; 95% CI 1.3–3.8) and patients < 50 years old (adjusted OR 3.3; 95% CI 1.7–6.6) had higher odds of having a CaWeb. Of 58 confirmed symptomatic CaWeb patients, 5 (8.8%) had recurrent ischemic stroke compared to 86/5,240 patients (1.8%) without CaWeb (adjusted HR 5.0; 95% CI 2.0–12.8, Figure 1). Final results will be presented at the conference. Conclusions In patients with LVO stroke, CaWebs are more common in women and younger patients, and are associated with a substantially increased risk of early recurrent ischemic stroke. Conflict of interest Nothing to disclose. Figure 1 - belongs to Results