Abstract A011: SymptomatiC stratificatiOn based on moRphological fEatures of carotid WEB (SCORE-WEB)

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Introduction: Carotid web (CaW) is an underrecognized cause of cryptogenic stroke, though many cases are incidentally detected. Morphologic determinants of symptomatic presentation remain unclear. Hypothesis: We hypothesized that selected morphologic features could distinguish symptomatic from incidental CaWs and be combined into a practical risk score. Methods: We conducted a cross-sectional analysis of patients with CaW diagnosed at a comprehensive stroke center (2014–2024). CaWs were deemed symptomatic if associated with ipsilateral ischemic events without competing etiologies. High-resolution computed tomography angiography with thin-slice reconstructions was used for morphologic assessment. Five parameters, i) pre-web angle, ii) pocket area, iii) lesion length, iv) bulb caliber, and v) distal caliber, were selected based on physiologic plausibility and prior evidence. A simplified morphological risk score (SCORE-CAW) ( Table 1 ) was derived. Each variable was discretized into one to five strata. Cutoffs were defined at points where symptomatic rates shifted meaningfully (0.1 mm for size, 0.5 mm2 for area, 1° for angle), then consolidated into clinically practical thresholds. Adjacent intervals were merged to preserve monotonicity. SCORE-CAW ranges from 5–16 points, with higher scores reflecting greater symptomatic risk. Discrimination was assessed using area under the receiver operating characteristic curve (AUC). Results: Among 110 patients (80 symptomatic, 30 asymptomatic; median age 50, 69% women), symptomatic CaWs showed smaller pre-web angles, larger pocket areas, longer lesion length, smaller bulb calibers, and larger distal calibers. The multivariable model achieved an AUC of 0.803 ( Figure 1 ). The simplified SCORE-CAW preserved accuracy (AUC 0.824), with monotonic increases in symptomatic risk across strata ( Figure 2 ). A threshold ≥12 points yielded sensitivity 0.54, while ≤7 points reliably excluded symptomatic cases (sensitivity 0.99). Conclusions: SCORE-CAW, based on five reproducible morphologic features, accurately discriminates symptomatic from incidental CaWs. This pragmatic tool offers a standardized framework for risk stratification and may guide patient selection for preventive interventions. Multicenter validation is warranted.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.