Ultrasonographic Imaging Features of Carotid Webs Correlate With the Risk of Stroke.

Objective: The carotid web has been increasingly recognized as a potential source of thromboembolism in ischemic stroke patients who do not have conventional stroke risk factors. Ultrasound is the most commonly used imaging technique for initial screening. In this study, we aimed to investigate the morphologic characteristics of carotid web and their correlation with stroke using ultrasound.

Methods: We retrospectively analyzed carotid ultrasonography data diagnosed with acute ischemic stroke and carotid web between July 2020 and December 2024. The presence of carotid web was confirmed using digital subtraction angiography and carotid ultrasound. Patients were categorized into symptomatic carotid web group or asymptomatic carotid web group based on whether they had an acute ischemic stroke ipsilateral to the carotid web. We compared baseline data and morphologic variables of the carotid webs, including length, thickness, and angle between the 2 groups.

Results: A total of 18 carotid webs were identified for this study. Patients in the symptomatic carotid web group had significantly longer webs compared with those in the asymptomatic carotid web group. However, the angle between the carotid web and the carotid wall, as well as the thickness of the carotid web, did not differ significantly between the 2 groups. A carotid web length of ≥3.4 mm was identified as the optimal threshold associated with stroke.

Conclusions: Ultrasound is effective in thoroughly delineating the morphologic characteristics of carotid web. Individuals with longer carotid web are more likely to experience acute ischemic stroke.