Antiplatelet therapy for primary prevention of stroke in patients with carotid web: a prospective cohort study.
- 1Department of Geriatric Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China.
- 2Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
- 3Department of Neurology, Medical College of Georgia Augusta University, Augusta, GA, United States.
Abstract
Background
Carotid webs have emerged as an etiology for ischemic stroke in younger patients, with a high recurrence rate. However, the optimal prevention strategy for asymptomatic carotid webs remains uncertain.Methods
This prospective cohort study was conducted at the Affiliated Hospital of Qingdao University between June 2017 and June 2022, including patients diagnosed with asymptomatic carotid webs via CT angiography (CTA), to evaluate the efficacy of antiplatelet therapy as primary prevention of stroke. The primary outcome was the incidence of ischemic stroke. Patients receiving oral anticoagulants or with other etiologies for stroke were excluded. Cox regression with Firth's penalized maximum likelihood method was used to evaluate the association between antiplatelet therapy and stroke. Propensity scores were applied in sensitive analysis.Results
A total of 105 patients (median age, 61 years; range, 19-80 years), including 53 (50.5%) male patients, were included. Altogether 31 patients received single antiplatelet therapy. During a median follow-up of 31 months (range from 9 to 89 months), ischemic stroke occurred in 3 of 31 patients (incidence rate, 3.51 per 100 person-years, 95% CI = 0.72-10.25) in the antiplatelet group and 10 of 74 patients (5.16 per 100 person-years, 95% CI = 2.18-9.50) in the non-antiplatelet group. The estimated association favored antiplatelet therapy but was imprecise (HR = 0.755, 95% CI = 0.215-2.653, p = 0.642). Similar results were observed after adjustment for atherosclerotic cardiovascular disease (ASCVD) risk and concurrent stenosis, as well as in propensity score-adjusted analyses. Subgroup analysis of patients without high ASCVD risk demonstrated no significant association between antiplatelet therapy and stroke (HR = 0.671, 95% CI = 0.108-4.191, p = 0.638).Conclusion
In this prospective cohort, stroke incidence was numerically lower with single antiplatelet therapy, but estimates were imprecise and compatible with both benefit and harm.
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BibTeX
@article{wang2026antiplatelet,
title = {{Antiplatelet therapy for primary prevention of stroke in patients with carotid web: a prospective cohort study.}},
author = {Xiaomeng Wang and Pu Liu and Yi Hu and Yuzhu Zhang and Jingjiao Chen and Sijia Tian and Xiaosa Chi},
journal = {Frontiers in neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1955675},
url = {https://europepmc.org/article/MED/42908825},
note = {CC BY},
}
RIS
TY - JOUR
TI - Antiplatelet therapy for primary prevention of stroke in patients with carotid web: a prospective cohort study.
AU - Xiaomeng Wang
AU - Pu Liu
AU - Yi Hu
AU - Yuzhu Zhang
AU - Jingjiao Chen
AU - Sijia Tian
AU - Xiaosa Chi
PY - 2026
DA - 2026/10/07
JO - Frontiers in neurology
DO - 10.3389/fneur.2026.1955675
UR - https://europepmc.org/article/MED/42908825
AB - Background Carotid webs have emerged as an etiology for ischemic stroke in younger patients, with a high recurrence rate. However, the optimal prevention strategy for asymptomatic carotid webs remains uncertain.Methods This prospective cohort study was conducted at the Affiliated Hospital of Qingdao University between June 2017 and June 2022, including patients diagnosed with asymptomatic carotid webs via CT angiography (CTA), to evaluate the efficacy of antiplatelet therapy as primary prevention of stroke. The primary outcome was the incidence of ischemic stroke. Patients receiving oral anticoagulants or with other etiologies for stroke were excluded. Cox regression with Firth's penalized maximum likelihood method was used to evaluate the association between antiplatelet therapy and stroke. Propensity scores were applied in sensitive analysis.Results A total of 105 patients (median age, 61 years; range, 19-80 years), including 53 (50.5%) male patients, were included. Altogether 31 patients received single antiplatelet therapy. During a median follow-up of 31 months (range from 9 to 89 months), ischemic stroke occurred in 3 of 31 patients (incidence rate, 3.51 per 100 person-years, 95% CI = 0.72-10.25) in the antiplatelet group and 10 of 74 patients (5.16 per 100 person-years, 95% CI = 2.18-9.50) in the non-antiplatelet group. The estimated association favored antiplatelet therapy but was imprecise (HR = 0.755, 95% CI = 0.215-2.653, p = 0.642). Similar results were observed after adjustment for atherosclerotic cardiovascular disease (ASCVD) risk and concurrent stenosis, as well as in propensity score-adjusted analyses. Subgroup analysis of patients without high ASCVD risk demonstrated no significant association between antiplatelet therapy and stroke (HR = 0.671, 95% CI = 0.108-4.191, p = 0.638).Conclusion In this prospective cohort, stroke incidence was numerically lower with single antiplatelet therapy, but estimates were imprecise and compatible with both benefit and harm.
SN - 1664-2295
ER -