Carotid web ultrasonography and its associations with ischemic stroke: a preliminary observational study

This study aims to characterize the carotid web (CW) via Ultrasonography and explore its structural correlations with cerebral ischemic stroke (CIS). We retrospectively reviewed 11,656 patients hospitalized in the neurology department of our center who underwent carotid ultrasonography at our center between January 2018 and December 2024. Patients were included if they had CTA within 2 weeks of ultrasound. We calculated CW incidence with 95% confidence intervals (CIs) and compared baseline characteristics, lipid profiles, and ultrasonic features (length, thickness, web angle, atherosclerotic plaque, thrombus) between patients with and without CIS. A total of 138 patients with 140 carotid webs (CWs) were identified by consensus between CTA and ultrasound, including 2 cases with bilateral CWs. The incidence of CW was 2.9% (95% CI: 2.5%–3.4%), with a mean age of 60.6±12.7 years and 66.4% male (n = 93). Fifty-four patients with 54 CWs and cerebral ischemic strokes were assigned to the CIS group, while 84 patients with 86 asymptomatic CWs were in the non-CIS group. CIS patients were younger and had lower rates of hypertension, hyperlipidemia, and coronary artery disease (P＜0.01,P = 0.002, P = 0.037), along with decreased levels of cholesterol (P= 0.005), triglyceride (P = 0.029), and low-density lipoprotein (P = 0.002). Ipsilateral middle cerebral artery severe stenosis or occlusion was significantly more frequent in the CIS group (20.4% vs. 1.2%, P<0.01). CWs in the CIS group were longer (8.0 vs. 5.9 mm, P=0.002) and thicker (1.2 vs. 1.0 mm, P=0.001) but had a smaller angle (42.5° vs. 59.0°, P=0.002). Thrombus association was more common in the CIS group (29.6% vs. 3.5%, P<0.01), while atherosclerotic plaque (35.2% vs. 54.7%, P = 0.025) and ≥50% carotid stenosis (18.5% vs. 39.5%, P = 0.009) were less frequent. Patients with CW complicated by CIS were younger, exhibited longer and thicker CWs, smaller web angles, and a significantly higher prevalence of thrombus compared to the asymptomatic patients.