Carotid web and ischemic stroke: a CT angiography study.

Objectives: We sought to explore the prevalence, demographics, clinical and imaging features of the Carotid web (CaW) on CT angiography (CTA) in patients with cryptogenic and non-cryptogenic stroke through a large-scale retrospective study.

Materials And Methods: A total of 1662 patients with ischemic stroke and had a neck CTA were retrospectively reviewed. An extensive clinical workup was performed to identify patients with cryptogenic stroke. All neck CTA studies were reconstructed and independently evaluated by two experienced radiologists for presence or absence of CaW on the ipsilateral and contralateral to the stroke side.

Results: Thirty-three cases of CaW were eventually diagnosed in patients with ischemic stroke, with a prevalence of 2.2% (33/1489) in a hospital-based series. Twenty-six (26/33, 78.8%) cases of CaW were ipsilateral to the stroke side. There are 18 ipsilateral CaWs (18/285, 6.3%) in cryptogenic stroke patients, and eight ipsilateral CaWs (8/1204, 0.7%) in non-cryptogenic stroke, yielding an odds ratio of 10.1. Cryptogenic stroke patients with ipsilateral CaW were relatively young with a higher prevalence of women. The interrater and intrarater agreement on the CTA based diagnosis of CaW were substantial.

Conclusions: Our results demonstrate a strong correlation between the CaW and cryptogenic stroke in large Asian study population. CTA is the imaging modality of choice for detecting CaW.