Carotid Revascularization Superior to Medical Management in Preventing Recurrent Stroke in People with Ipsilateral Carotid Web

Relative to carotid revascularization, medical management (antiplatelet or anticoagulation therapy) was associated with increased risk of recurrent ischemic stroke in patients with ischemic stroke and ipsilateral carotid web according to results of a systematic review and meta-analysis presented at the American Academy of Neurology Annual Meeting 2025. These results suggest that carotid revascularization should be considered to mitigate recurrence risk in this patient population.

In this PROSPERO–registered systematic review (CRD42024485069), researchers analyzed data obtained from 5 databases: Embase, Scopus, MEDLINE, Web of Science, and CINAHL. The analysis included a total of 14 studies with 513 participants. These studies were selected based on their comparison of recurrent ischemic stroke rates between people with ipsilateral carotid web receiving either carotid revascularization (n=272) or medical management, consisting of antiplatelet or anticoagulation therapy (n=241). Within the carotid revascularization group, 129 patients underwent carotid endarterectomy (CEA), and 143 underwent carotid artery stenting (CAS).

• Medical management was associated with a higher risk of recurrent stroke compared to carotid intervention (relative risk [RR], 1.23; 95% CI, 1.08 to 1.40; P<.001; I²=24.9%).
• A comparative analysis of those who received an intervention revealed that both CAS and CEA procedures were equally effective approaches for secondary stroke prevention (RR, 1.01; 95% CI, 0.136 to 1.59; P=.70; I²=0%) with similar complication rates.

These findings highlight the potential benefits of carotid revascularization over medical management in reducing ischemic stroke recurrence among patients with ipsilateral carotid web. The authors, who are affiliated with Brown University, Nottingham University Hospitals, and Ziauddin Medical University, note that larger studies are needed to confirm their results.

Source: Khan F, Gujjar AR, Fletcher L, et al. Carotid revascularization vs. medical management for ischemic stroke with ipsilateral carotid web: a systematic review and meta-analysis. Presented at: American Academy of Neurology Annual Meeting; April 5–9, 2025; San Diego, CA.