Clinical and CT angiography characteristics of Chinese stroke patients with carotid web: a retrospective study.

BACKGROUND

Carotid web (CaW) is a recognized risk factor for ischemic stroke, histopathologically classified as intimal fibromuscular dysplasia. However, clinical and imaging characteristics of CaW may vary across ethnic populations, and data from the Chinese population remain limited. This study aimed to investigate the clinical and computed tomography angiography (CTA) characteristics of CaW in Chinese stroke patients.

METHODS

We retrospectively reviewed CTA examinations of 9,220 patients at a single center in southern China from November 2005 to February 2021. Patients with CaW diagnosed on CTA were identified. Demographic data, clinical presentations, comorbidities, and CTA features including location, orientation, lumen dimensions, and stenosis severity were analyzed. Comparisons between cerebral infarction and non-cerebral infarction groups were performed using independent-sample t-tests and Fisher's exact test.

RESULTS

A total of 34 patients (32 males, 2 females; mean age 56.97 ± 14.75 years) with 42 CaWs were identified (prevalence 0.37%). The majority of CaWs (37/42, 88.1%) were located at the common carotid artery (CCA) bifurcation, with 5 (11.9%) at the internal carotid artery (ICA) bulb. Unilateral CaW was found in 26 patients (76.5%) and bilateral in 8 (23.5%). Cerebral infarction was the most common diagnosis (21/34, 61.8%). The lumen diameter at the CaW site was significantly different between the cerebral infarction and non-infarction groups (8.97 ± 2.34 mm vs. 6.80 ± 1.90 mm, P = 0.008). Hypertension was significantly more prevalent in the cerebral infarction group (76.2 vs. 23.1%, P = 0.004). Mild stenosis (1%-30%) accounted for 64.7% of cases per NASCET criteria.

CONCLUSIONS

In the Chinese population, CaW predominantly affects males and tends to be unilateral, located at the CCA bifurcation. CaW-induced mild carotid stenosis constituted the majority of cases. CaW is an important risk factor for cryptogenic cerebral infarction. The lumen diameter at CaW sites and hypertension were significantly associated with cerebral infarction, highlighting the need for careful CTA evaluation and individualized management strategies.