Carotid webs (CW) are shelf-like projections into the internal carotid artery (ICA) bulb and are a significant etiology of cryptogenic stroke, particularly in younger patients. Recently, CW have been found to have a prevalence of up 37% in patients with cryptogenic stroke and 7% in the general population. The natural evolution of CW and the stroke risk for an individual patient with CW is unknown. Therefore, there is no consensus on optimal management of these patients. We hypothesize that ICA bulbs containing CW will demonstrate complex flow patterns on 4D MR flow imaging and that this disrupted flow presents an environment for thrombus development distal to the CW. Furthermore, we hypothesize that there will be a positive correlation between altered flow metrics in patients with CW and the presence of stroke. In order to test these hypotheses, we propose a cohort and longitudinal study using advanced 4D MR flow, vessel wall, and brain imaging in patients with CW and healthy controls with the following aims: (1) to define the 4D MRI flow metrics of CW in comparison to normal ICA bulbs, (2) to determine the correlation between 4D MRI flow metrics and ipsilateral anterior circulation strokes, and (3) to determine the longitudinal stability/progression of CW and associated 4D MRI flow metrics. The proposed multi-disciplinary team is ideal for this research and includes Dr. Jason Allen (PI), a neuroradiologist and neurologist, Dr. Diogo Haussen, a neurointerventionalist and neurologist, and Dr. John Oshinski, an expert in flow dynamics and advanced MR imaging. The research environment is also ideal as Emory and Grady Memorial Hospital have busy stroke services, treating nearly 4000 patients per year, and Drs. Allen and Haussen have recently published our research on carotid stenting for CW treatment. The results of our proposed study will have a significant impact upon our understanding of the mechanisms of CW-related stroke, a current important knowledge gap. This knowledge will potentially improve patient prognostication and guide treatment decisions, leading to decreased stroke incidence in patients with CW.
|Program type||Innovative Project Award|
|Effective start/end date||07/01/2019 → 12/02/2019|