In this prospective cohort of 105 patients with asymptomatic carotid webs, stroke incidence was numerically lower with single antiplatelet therapy, but estimates were imprecise and compatible with both benefit and harm.
Key Findings
Results
Ischemic stroke incidence was numerically lower in patients on single antiplatelet therapy than in those not on antiplatelet therapy, but the difference was not statistically significant.
Ischemic stroke occurred in 3 of 31 patients (3.51 per 100 person-years, 95% CI = 0.72-10.25) in the antiplatelet group.
Ischemic stroke occurred in 10 of 74 patients (5.16 per 100 person-years, 95% CI = 2.18-9.50) in the non-antiplatelet group.
Median follow-up was 31 months (range 9 to 89 months).
Results
The Cox regression with Firth's penalized maximum likelihood estimated a hazard ratio favoring antiplatelet therapy, but the estimate was imprecise.
HR = 0.755, 95% CI = 0.215-2.653, p = 0.642.
The confidence interval is compatible with both substantial benefit and harm.
Firth's method was used because of the small number of events.
Results
Results were similar after adjusting for ASCVD risk and concurrent stenosis, and in propensity score-adjusted sensitivity analyses.
Adjustment covariates included atherosclerotic cardiovascular disease (ASCVD) risk and concurrent carotid stenosis.
Propensity scores were applied in sensitivity analyses.
The abstract reports that adjusted and propensity-score results were similar to the primary estimate.
Results
In patients without high ASCVD risk, antiplatelet therapy was not significantly associated with stroke.
Subgroup HR = 0.671, 95% CI = 0.108-4.191, p = 0.638.
The wide confidence interval reflects the small number of events in the subgroup.
Methods
The cohort comprised 105 patients with asymptomatic carotid webs diagnosed by CTA, of whom 31 received single antiplatelet therapy.
Median age was 61 years (range 19-80); 53 (50.5%) were male.
Patients were enrolled at the Affiliated Hospital of Qingdao University between June 2017 and June 2022.
Patients on oral anticoagulants or with other stroke etiologies were excluded.
The primary outcome was incidence of ischemic stroke.
Background
The optimal primary prevention strategy for asymptomatic carotid webs remains uncertain, since carotid webs are an etiology of ischemic stroke in younger patients with a high recurrence rate.
The study was designed to evaluate antiplatelet therapy as primary prevention in asymptomatic patients.
The authors conclude that the data are compatible with both benefit and harm and do not establish efficacy.
What This Means
A carotid web is a thin shelf-like growth inside a neck artery that can cause clots and stroke, sometimes in fairly young people. It is unclear whether people whose webs have been found before any stroke should take antiplatelet medicines (such as aspirin) to prevent a first stroke. This study followed 105 such patients at one Chinese hospital for a median of about 2.6 years, comparing 31 who took a single antiplatelet drug with 74 who did not.
Strokes occurred in 3 of 31 patients on antiplatelet therapy and 10 of 74 not on it. That is a somewhat lower rate with treatment, but the difference was small and could easily be due to chance. The statistical estimate was very imprecise, which means the data are consistent with the medicine helping, doing nothing, or even causing harm. Adjusting for other stroke risk factors, using propensity scores, and looking at lower-risk patients gave similar results.
This research suggests that it is still not known whether antiplatelet therapy prevents a first stroke in people with asymptomatic carotid webs. The study was small, had few stroke events, was not randomized, and came from a single center, so larger studies are needed to answer the question.
Wang X, Liu P, Hu Y, Zhang Y, Chen J, Tian S, et al.. (2026). Antiplatelet therapy for primary prevention of stroke in patients with carotid web: a prospective cohort study.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1955675