Carotid Web Survey Responses by Subspecialty and Overall
Type of Respondent | |||||
---|---|---|---|---|---|
Survey Question/Response | General Neurologist | Vascular Neurologist | Neuroradiologist | Neurointerventionalist | All |
1. In what capacity do you practice? (select all that apply) | |||||
General neurologist | 6 (8) | ||||
Vascular neurologist | 11 (15) | ||||
Neuroradiologist | 10 (14) | ||||
Neurointerventionalist | 47 (64) | ||||
2. How familiar are you with this disease entity? | |||||
Never heard of it | 1 (17) | 1 (9) | 0 (0) | 3 (7) | 5 (7) |
Limited clinical practice | 5 (83) | 4 (36) | 6 (60) | 17 (38) | 32 (44) |
Routine clinical practice | 0 (0) | 5 (45) | 4 (40) | 24 (53) | 33 (46) |
Extensive clinical practice | 0 (0) | 1 (9) | 0 (0) | 1 (2) | 2 (3) |
3. How frequently do you encounter carotid webs? | |||||
Never | 5 (83) | 3 (27) | 1 (10) | 7 (15) | 16 (22) |
1-2 cases per year | 1 (17) | 2 (18) | 5 (50) | 21 (45) | 29 (39) |
3-5 cases per year | 0 (0) | 2 (18) | 2 (20) | 13 (28) | 17 (23) |
6-10 cases per year | 0 (0) | 4 (36) | 2 (20) | 3 (6) | 9 (12) |
>10 cases per year | 0 (0) | 0 (0) | 0 (0) | 3 (6) | 3 (4) |
4. What imaging modality most commonly put carotid web in the differential diagnosis (even if further imaging was sought)? | |||||
(select all that apply) | |||||
Conventional DSA | 0 (0) | 4 (31) | 2 (13) | 15 (23) | 21 (21) |
CTA | 3 (43) | 8 (62) | 10 (63) | 37 (57) | 58 (57) |
MRA contrast enhanced | 1 (14) | 0 (0) | 2 (13) | 7 (11) | 10 (10) |
MRA time of flight | 0 (0) | 0 (0) | 1 (6) | 2 (3) | 3 (3) |
MRI vessel wall imaging | 0 (0) | 0 (0) | 1 (6) | 1 (2) | 2 (2) |
Ultrasound Doppler | 0 (0) | 0 (0) | 0 (0) | 3 (5) | 3 (3) |
Other (please specify)a | 3 (43) | 1 (8) | 0 (0) | 0 (0) | 4 (4) |
5. Which imaging modalities do you prefer to confirm the diagnosis of carotid web? (select all that apply) | |||||
Conventional DSA | 1 (13) | 9 (69) | 4 (36) | 36 (59) | 50 (54) |
CTA | 2 (25) | 2 (15) | 6 (55) | 13 (21) | 23 (25) |
MRA contrast enhanced | 2 (25) | 2 (15) | 1 (9) | 5 (8) | 10 (11) |
MRA time of flight | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
MRI vessel wall imaging | 0 (0) | 0 (0) | 0 (0) | 3 (5) | 3 (3) |
Ultrasound Doppler | 0 (0) | 0 (0) | 0 (0) | 3 (5) | 3 (3) |
Other (please specify)a | 3 (38) | 0 (0) | 0 (0) | 1 (2) | 4 (4) |
6. What is your preferred treatment of a carotid web in asymptomatic patients? | |||||
Don’t know | 4 (67) | 2 (18) | 3 (30) | 5 (11) | 14 (19) |
Nothing | 0 (0) | 4 (36) | 1 (10) | 12 (26) | 17 (23) |
Follow-up imaging only | 0 (0) | 0 (0) | 1 (10) | 1 (2) | 2 (3) |
Aspirin only | 1 (17) | 3 (27) | 4 (40) | 21 (45) | 29 (39) |
Plavix (clopidogrel) only | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Dual antiplatelet (aspirin/Plavix) | 1 (17) | 2 (18) | 1 (10) | 7 (15) | 11 (15) |
Coumadin (warfarin) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
NOAC/DOAC | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Stent | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Endarterectomy | 0 (0) | 0 (0) | 0 (0) | 1 (2) | 1 (1) |
7. What is your preferred treatment of a carotid web in the setting of acute (ischemic) stroke? | |||||
Don’t know | 4 (67) | 1 (9) | 3 (30) | 4 (9) | 12 (16) |
Nothing | 0 (0) | 0 (0) | 0 (0) | 5 (11) | 5 (7) |
Follow-up imaging only | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Aspirin only | 0 (0) | 5 (45) | 3 (30) | 11 (23) | 19 (26) |
Plavix (clopidogrel) only | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Dual antiplatelet (aspirin/Plavix) | 1 (17) | 1 (9) | 3 (30) | 14 (30) | 19 (26) |
Coumadin (warfarin) | 0 (0) | 1 (9) | 0 (0) | 0 (0) | 1 (1) |
NOAC/DOAC | 0 (0) | 1 (9) | 0 (0) | 2 (4) | 3 (4) |
Stent | 0 (0) | 0 (0) | 1 (10) | 9 (19) | 10 (14) |
Endarterectomy | 1 (17) | 2 (18) | 0 (0) | 2 (4) | 5 (7) |
8. What is your preferred treatment of a carotid web in the setting of multiple recurrent (ischemic) strokes? | |||||
Don’t know | 3 (50) | 3 (27) | 4 (40) | 4 (9) | 14 (19) |
Nothing | 0 (0) | 0 (0) | 0 (0) | 2 (4) | 2 (3) |
Follow-up imaging only | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Aspirin only | 0 (0) | 0 (0) | 0 (0) | 2 (4) | 2 (3) |
Plavix (clopidogrel) only | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Dual antiplatelet (aspirin/Plavix) | 0 (0) | 0 (0) | 0 (0) | 5 (11) | 5 (7) |
Coumadin (warfarin) | 0 (0) | 1 (9) | 0 (0) | 0 (0) | 1 (1) |
NOAC/DOAC | 1 (17) | 0 (0) | 0 (0) | 1 (2) | 2 (3) |
Stent | 1 (17) | 3 (27) | 3 (30) | 22 (47) | 29 (39) |
Endarterectomy | 1 (17) | 4 (36) | 3 (30) | 11 (23) | 19 (26) |
Notes: All data are reported as n (%). Questions 1, 4, and 5 allowed for multiple responses (“select all that apply”), reflected in the percentages in the All category.
↵aOther responses included “Have not personally encountered,” “Never heard of carotid web,” and “I do not ever decide on how to work up carotid webs.”
CTA, computed tomography angiography; DSA, digital subtraction angiography; MRA, magnetic resonance angiography; MRI, magnetic resonance imaging; NOAC/DOAC, novel oral anticoagulant/direct-acting anticoagulant.