Carotid web is a non-atherosclerotic, shelf-like intimal projection arising most often from the posterior wall of the carotid bulb or proximal internal carotid artery. It is considered an atypical intimal fibromuscular dysplasia phenotype. The web disturbs local carotid flow, promotes stasis and thrombus formation in the web pouch, and can cause downstream artery-to-artery embolic ischemic stroke.
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name: Carotid web
creation_date: "2026-05-05T20:46:40Z"
updated_date: "2026-05-05T22:45:00Z"
category: Complex
description: >-
Carotid web is a non-atherosclerotic, shelf-like intimal projection arising
most often from the posterior wall of the carotid bulb or proximal internal
carotid artery. It is considered an atypical intimal fibromuscular dysplasia
phenotype. The web disturbs local carotid flow, promotes stasis and thrombus
formation in the web pouch, and can cause downstream artery-to-artery embolic
ischemic stroke.
disease_term:
preferred_term: carotid web
term:
id: MONDO:0979323
label: carotid web
synonyms:
- Carotid artery web
- Carotid bulb web
- Carotid diaphragm
parents:
- Vasculopathy
- Cerebrovascular Disease
definitions:
- name: Imaging and anatomic definition of carotid web
definition_type: CASE_DEFINITION
description: >-
Carotid web is recognized as a fibrous shelf-like intimal flap projecting
into the lumen from the posterior wall of the internal carotid bulb.
scope: Imaging-defined carotid web in stroke and vascular-neurology practice
evidence:
- reference: DOI:10.1136/jnis-2023-021243
reference_title: "Carotid webs: a review of pathophysiology, diagnostic findings, and treatment options"
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
A carotid web (CaW) is an atypical form of fibromuscular dysplasia
characterized by a fibrous, shelf-like intimal flap originating from the
posterior wall of the internal carotid bulb projecting into the arterial
lumen.
explanation: >-
This review abstract directly defines the anatomic lesion.
pathophysiology:
- name: Intimal shelf lesion of the carotid bulb
description: >-
A fibrous intimal projection in the carotid bulb or proximal internal
carotid artery narrows and reshapes the local lumen without typical
atherosclerotic plaque biology.
cell_types:
- preferred_term: smooth muscle cell
term:
id: CL:0000192
label: smooth muscle cell
locations:
- preferred_term: internal carotid artery
term:
id: UBERON:0001532
label: internal carotid artery
- preferred_term: carotid sinus
term:
id: UBERON:0003708
label: carotid sinus
biological_processes:
- preferred_term: blood vessel remodeling
term:
id: GO:0001974
label: blood vessel remodeling
modifier: ABNORMAL
evidence:
- reference: DOI:10.5853/jos.2025.00626
reference_title: >-
Carotid Web: An Update Focusing on Its Relationship With Fibromuscular
Dysplasia and Therapeutic Strategy
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Carotid web was described more than 50 years ago as an atypical
fibromuscular dysplasia (FMD) subtype with highly supporting pathological
evidence as intimal FMD.
explanation: >-
This supports the intimal-FMD framing of the carotid web lesion.
downstream:
- target: Pro-thrombotic carotid hemodynamics
description: The shelf-like pouch creates low-flow and disturbed-flow zones that promote local thrombus formation.
causal_link_type: DIRECT
evidence:
- reference: DOI:10.1136/jnis-2023-021243
reference_title: "Carotid webs: a review of pathophysiology, diagnostic findings, and treatment options"
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
CaWs disturb normal blood flow and create stasis between the intimal
reflection and the carotid wall, thereby promoting thrombogenesis and
increasing the risk of downstream embolic strokes.
explanation: >-
This directly links the web anatomy to stasis, thrombogenesis, and
embolic stroke risk.
- name: Pro-thrombotic carotid hemodynamics
description: >-
Patient-specific flow modeling shows that carotid webs create larger regions
of low shear, high oscillatory shear, low velocity, and flow stasis than
comparable mild atherosclerotic lesions or normal carotid bifurcations.
cell_types:
- preferred_term: endothelial cell
term:
id: CL:0000115
label: endothelial cell
- preferred_term: platelet
term:
id: CL:0000233
label: platelet
biological_processes:
- preferred_term: blood coagulation
term:
id: GO:0007596
label: blood coagulation
modifier: INCREASED
- preferred_term: platelet activation
term:
id: GO:0030168
label: platelet activation
modifier: INCREASED
evidence:
- reference: DOI:10.1038/s41598-024-60666-7
reference_title: >-
Subjects with carotid webs demonstrate pro-thrombotic hemodynamics compared
to subjects with carotid atherosclerosis
supports: SUPPORT
evidence_source: COMPUTATIONAL
snippet: >-
Patients with CaW had significantly larger regions containing low shear
rate, high OSI, low velocity, and flow stasis in comparison to subjects
with mild atherosclerosis or normal bifurcations.
explanation: >-
Computational fluid dynamics data support pro-thrombotic hemodynamic
conditions in carotid webs.
downstream:
- target: Embolic ischemic stroke
description: Thrombus generated at the web can embolize to intracranial arteries and cause acute ischemic stroke.
causal_link_type: DIRECT
phenotypes:
- name: Embolic ischemic stroke
category: Neurologic
diagnostic: true
description: >-
Symptomatic carotid web most often presents with ipsilateral ischemic stroke,
including large-vessel occlusion, in patients who may lack conventional
vascular risk factors.
phenotype_term:
preferred_term: Ischemic stroke
term:
id: HP:0002140
label: Ischemic stroke
evidence:
- reference: DOI:10.1002/acn3.52161
reference_title: In-hospital recurrent stroke in ipsilateral carotid web patients undergoing thrombectomy
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Carotid artery web is a possible cause of ischemic stroke, especially in
young patients who lack conventional risk factors.
explanation: >-
This directly supports ischemic stroke as the major clinical presentation.
- name: Recurrent ischemic stroke
category: Neurologic
description: >-
Symptomatic ipsilateral carotid web is associated with a higher risk of early
and longer-term recurrent ischemic stroke.
phenotype_term:
preferred_term: Ischemic stroke
term:
id: HP:0002140
label: Ischemic stroke
evidence:
- reference: DOI:10.1002/acn3.52161
reference_title: In-hospital recurrent stroke in ipsilateral carotid web patients undergoing thrombectomy
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
When compared to patients without ipsilateral carotid web, those with an
ipsilateral carotid web had a higher risk of recurrent ischemic stroke
(adjusted RR: 4.38, 95% CI: 1.38–13.85) and recurrent ipsilateral large
vessel occlusion (adjusted RR: 4.49, 95% CI: 1.41–14.21).
explanation: >-
This cohort directly supports elevated early recurrence risk in carotid
web-associated large-vessel occlusion.
- name: Transient ischemic attack
category: Neurologic
description: >-
Symptomatic carotid web can present with transient ischemic attack in a
minority of registry cases.
phenotype_term:
preferred_term: Transient ischemic attack
term:
id: HP:0002326
label: Transient ischemic attack
evidence:
- reference: PMID:37724713
reference_title: >-
Clinical, imaging, and management features of symptomatic carotid web:
Insight from CAROWEB registry.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Between June 2019 and December 2021, 244 cases were submitted by 14
centers, 42 rejected, and 202 included (IS, 91.6%; TIA, 7.9%; retinal
infarction, 0.5%; mean age, 50.8 ± 12.2 years; female, 62.9%; Caucasian,
47.5%; Afro-Caribbean, 20.3%).
explanation: >-
This registry directly quantifies TIA among symptomatic carotid web
presentations.
progression:
- phase: Symptomatic embolic and recurrent stroke risk
age_range: Adult, often recognized in younger or otherwise cryptogenic stroke patients
notes: >-
The lesion may be clinically silent until an embolic event. Once symptomatic,
recurrence on medical therapy is a major management concern.
evidence:
- reference: DOI:10.1136/jnis-2023-021243
reference_title: "Carotid webs: a review of pathophysiology, diagnostic findings, and treatment options"
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Observational data have suggested that CaWs are associated with strokes
with otherwise unknown etiology, particularly in young patients without
other stroke factors, and stroke recurrence rates of symptomatic CaWs have
been reported to be as high as 20% over 2 years.
explanation: >-
This supports recognition in otherwise cryptogenic stroke and recurrent
stroke risk after symptoms develop.
biochemical: []
genetic: []
environmental: []
epidemiology:
- name: Female-predominant multicenter registry pattern
description: >-
A large French symptomatic carotid web registry found a female-predominant
adult cohort and included both Caucasian and Afro-Caribbean patients.
evidence:
- reference: PMID:37724713
reference_title: >-
Clinical, imaging, and management features of symptomatic carotid web:
Insight from CAROWEB registry.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Between June 2019 and December 2021, 244 cases were submitted by 14
centers, 42 rejected, and 202 included (IS, 91.6%; TIA, 7.9%; retinal
infarction, 0.5%; mean age, 50.8 ± 12.2 years; female, 62.9%; Caucasian,
47.5%; Afro-Caribbean, 20.3%).
explanation: >-
This provides cohort-level demographic context for symptomatic carotid
web.
treatments:
- name: Antithrombotic medical therapy
description: >-
Single or dual antiplatelet therapy, and sometimes anticoagulation, may be
used for symptomatic carotid web, but evidence remains observational and
management guidelines are not definitive.
treatment_term:
preferred_term: Pharmacotherapy
term:
id: NCIT:C15986
label: Pharmacotherapy
therapeutic_agent:
- preferred_term: acetylsalicylic acid
term:
id: CHEBI:15365
label: acetylsalicylic acid
evidence:
- reference: DOI:10.5853/jos.2025.00626
reference_title: >-
Carotid Web: An Update Focusing on Its Relationship With Fibromuscular
Dysplasia and Therapeutic Strategy
supports: PARTIAL
evidence_source: HUMAN_CLINICAL
snippet: >-
Treatment options in symptomatic cases include medical therapy (single or
dual antiplatelets) or interventional approach (surgery or stenting), but
there are no randomized controlled trials about therapy.
explanation: >-
This supports antiplatelet medical therapy as an option while preserving
uncertainty about the evidence base.
- name: Carotid revascularization by endarterectomy or stenting
description: >-
Carotid endarterectomy or carotid artery stenting may be considered in
selected symptomatic cases to eliminate the thrombogenic web pouch, but data
are based on observational evidence.
treatment_term:
preferred_term: surgical procedure
term:
id: MAXO:0000004
label: surgical procedure
evidence:
- reference: DOI:10.5853/jos.2025.00626
reference_title: >-
Carotid Web: An Update Focusing on Its Relationship With Fibromuscular
Dysplasia and Therapeutic Strategy
supports: PARTIAL
evidence_source: HUMAN_CLINICAL
snippet: >-
Treatment options in symptomatic cases include medical therapy (single or
dual antiplatelets) or interventional approach (surgery or stenting), but
there are no randomized controlled trials about therapy.
explanation: >-
This supports surgery or stenting as interventional options but indicates
that randomized evidence is lacking.
diagnosis:
- name: Multimodal non-invasive vascular imaging
description: >-
Carotid web diagnosis is usually made with non-invasive vascular imaging,
requiring concordance across two techniques; digital subtraction angiography
is reserved for diagnostic uncertainty or intervention.
diagnosis_term:
preferred_term: diagnostic procedure
term:
id: MAXO:0000003
label: diagnostic procedure
evidence:
- reference: DOI:10.5853/jos.2025.00626
reference_title: >-
Carotid Web: An Update Focusing on Its Relationship With Fibromuscular
Dysplasia and Therapeutic Strategy
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The diagnosis of carotid web is usually made by non-invasive techniques,
such as computed tomography angiography, ultrasound, and magnetic resonance
imaging, requiring the concordance of two different techniques for
confirming the diagnosis.
explanation: >-
This directly supports multimodal non-invasive imaging diagnosis.
- reference: DOI:10.5853/jos.2025.00626
reference_title: >-
Carotid Web: An Update Focusing on Its Relationship With Fibromuscular
Dysplasia and Therapeutic Strategy
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
DSA is usually considered in cases of diagnostic uncertainty and when
interventional treatment of ischemic stroke or carotid web is considered.
explanation: >-
This supports digital subtraction angiography as a follow-up diagnostic or
interventional modality in uncertain cases.
histopathology:
- name: Intimal fibromuscular dysplasia with web-pouch thrombi
diagnostic: true
description: >-
Pathology supports carotid web as an intimal fibromuscular dysplasia lesion
with small thrombi embedded in the web pouch, matching the thromboembolic
mechanism.
finding_term:
preferred_term: Intimal fibromuscular dysplasia with web-pouch thrombi
evidence:
- reference: DOI:10.5853/jos.2025.00626
reference_title: >-
Carotid Web: An Update Focusing on Its Relationship With Fibromuscular
Dysplasia and Therapeutic Strategy
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The pathology of the carotid web allowed identification of small thrombi
embedded in the web pouch, and the features of thrombi endovascularly
retrieved from intracranial arteries are very similar.
explanation: >-
This directly supports local thrombi in the carotid web pouch as a
histopathologic correlate.
Carotid web (CaW) is a non-atherosclerotic, shelf-like intimal projection arising classically from the posterior wall of the carotid bulb/proximal internal carotid artery (ICA) and is widely considered an intimal variant of fibromuscular dysplasia (FMD). Contemporary reviews and cohort studies support a mechanistic model in which CaW geometry creates flow separation and stasis in a “web pouch,” promoting local thrombosis and artery-to-artery embolism, leading to embolic cortical infarctions and large-vessel occlusion (LVO) strokes. Recurrence risk on medical therapy appears substantial in symptomatic webs (commonly summarized as ~10% annualized and ~20% over 2 years), whereas small observational series report low recurrence after carotid endarterectomy (CEA) or carotid artery stenting (CAS), though randomized trial data are lacking. (chen2024carotidwebsa pages 1-2, sayed2024subjectswithcarotid pages 1-2, zedde2025carotidweban pages 9-10)
A carotid web is an intraluminal, shelf-like intimal flap in the carotid bulb/proximal ICA. A widely used CTA definition is: “a thin intraluminal filling defect along the posterior wall of the carotid bulb just beyond the carotid bifurcation… seen as a septum on axial CTA.” (choi2015carotidwebsand pages 1-3)
Recent narrative reviews similarly define CaW as a “fibrous, shelf-like intimal flap originating from the posterior wall of the internal carotid bulb projecting into the arterial lumen” and emphasize its association with cryptogenic/embolic stroke. (chen2024carotidwebsa pages 1-2)
The retrieved information is primarily from aggregated disease-level resources (narrative reviews and systematic reviews) and observational human clinical cohorts/series, plus ClinicalTrials.gov registries. (chen2024carotidwebsa pages 1-2, ahmad2025carotidwebsa pages 1-3, NCT04431609 chunk 1)
Evidence is largely observational and heterogeneous. - Age: Often recognized in “young” patients with otherwise cryptogenic/LVO stroke, though CaW can occur across adult ages. (chen2024carotidwebsa pages 1-2, khan2024in‐hospitalrecurrentstroke pages 1-2) - Sex: Female predominance is repeatedly reported in reviews/cohorts. (chen2024carotidwebsa pages 1-1, ahmad2025carotidwebsa pages 3-4) - Ancestry/ethnicity: Associations with African descent/African American or “black population” are reported. (chen2024carotidwebsa pages 1-2, NCT04431609 chunk 1) - Traditional vascular risk factors: Reviews commonly emphasize CaW-associated strokes in patients lacking conventional risk factors, but CaW can coexist with plaque (a distinct subgroup evaluated in multimodal ultrasound cohorts). (khan2024in‐hospitalrecurrentstroke pages 1-2, hou2024thedifferencesbetween pages 1-3)
No protective genetic variants or protective environmental factors were identified in the retrieved sources.
No CaW-specific gene–environment interaction evidence was identified in the retrieved sources.
Carotid web itself is often asymptomatic until thromboembolism occurs; the clinically salient phenotype is ischemic stroke (often embolic/LVO) or TIA in the ipsilateral carotid territory.
Ischemic stroke (embolic, often LVO) - CaW is linked to embolic strokes and LVO; one review summarizes CaW as contributing to “2.5% of all large vessel occlusion strokes.” (chen2024carotidwebsa pages 1-2) - A thrombectomy cohort study (July 2015–March 2023) found ipsilateral CaW in 27/1463 (1.8%) thrombectomy patients; CaW patients were younger (median 60 vs 74 years) and often had no competing mechanism. (khan2024in‐hospitalrecurrentstroke pages 1-2)
Recurrent ischemic stroke - A classic CTA-era series reported recurrent stroke in 5/7 (71.4%) with recurrence occurring 1–97 months. (choi2015carotidwebsand pages 1-3) - Contemporary summaries cite recurrent events on medical therapy (see Prognosis/Treatment). (chen2024carotidwebsa pages 1-1)
Transient ischemic attack (TIA) - The CAROWEB registry includes patients with “cerebral infarction or transient ischemic attack” downstream of a CaW lesion. (NCT04431609 chunk 1)
(Exact mapping may vary by curator policy; these are appropriate candidates.) - Ischemic stroke — HP:0002140 - Transient ischemic attack — HP:0002327 - Cerebral infarction — HP:0002140 (often used for stroke) / consider ontology-specific infarction term if used locally - Hemiparesis — HP:0001269 (frequently reported in case presentations) (ahmad2025carotidwebsa pages 12-13) - Aphasia — HP:0002381 (reported in case presentations) (ahmad2025carotidwebsa pages 12-13) - Facial weakness — HP:0030319 (reported in case presentations) (ahmad2025carotidwebsa pages 12-13)
QoL instruments (EQ-5D/SF-36/PROMIS) were not reported in the retrieved evidence; functional outcomes in registries are typically captured as modified Rankin Scale (mRS) at 3–6 months (CAROWEB). (NCT04431609 chunk 1)
No CaW-specific causal genes or pathogenic variants were identified from the retrieved primary/clinical literature in this run.
No CaW-specific epigenomic/transcriptomic/proteomic/metabolomic signatures were identified in the retrieved sources.
No CaW-specific environmental toxins, lifestyle exposures, or infectious triggers were identified in the retrieved sources. CaW is generally framed as a structural arteriopathy rather than an exposure-driven condition. (chen2024carotidwebsa pages 1-2, sayed2024subjectswithcarotid pages 1-2)
A patient-specific computational fluid dynamics (CFD) study comparing CaW vs mild atherosclerosis vs normal bifurcations reported that CaW patients had significantly larger regions of low shear rate, high oscillatory shear index (OSI), low velocity, and flow stasis, consistent with a pro-thrombotic environment. (sayed2024subjectswithcarotid pages 1-2)
CaW is reviewed as an intimal-FMD-like lesion with intimal hyperplasia/fibroplasia; reviews summarize direct observation of thrombus adherent to or embedded within the lesion. (chen2024carotidwebsa pages 1-2, zedde2025carotidweban pages 3-5)
GO biological process (examples): - Blood coagulation — GO:0007596 - Platelet activation — GO:0030168 - Regulation of blood flow — GO:1903522 - Thrombus formation — (often modeled via coagulation/platelet activation terms)
Cell Ontology (CL) candidates (based on thrombosis & intimal remodeling): - Vascular smooth muscle cell — CL:0000192 (implicated by intimal hyperplasia concepts) (chen2024carotidwebsa pages 1-2) - Endothelial cell — CL:0000115 - Platelet — CL:0000233
UBERON anatomy: - Internal carotid artery — UBERON:0001496 - Common carotid artery — UBERON:0001644 - Carotid artery bifurcation / carotid bulb (anatomic region; may require local mapping)
No CaW-specific subcellular compartment abnormalities were identified.
No established Mendelian inheritance pattern is supported in the retrieved sources. Familial screening and polymorphism studies are ongoing/in planning. (NCT06336083 chunk 1, NCT05475080 chunk 1)
CTA (computed tomography angiography) - Key definition (CTA): “thin intraluminal filling defect… posterior wall… seen as a septum on axial CTA.” (choi2015carotidwebsand pages 1-3) - Oblique/sagittal reconstructions are emphasized in reviews for best visualization. (chen2024carotidwebsa pages 1-2)
DSA (digital subtraction angiography) - Used for diagnostic uncertainty and for intervention planning; reviews describe a linear filling defect with delayed/late contrast retention. (zedde2025carotidweban pages 9-10)
Ultrasound (DUS), CEUS, and microvascular flow imaging (SMI) - A 2024 cohort study used CEUS and SMI to differentiate CaW vs CaW with plaque and to identify typical features (including a thin triangular endoluminal defect on SMI). (hou2024thedifferencesbetween pages 1-3, hou2024thedifferencesbetween media c303a27b)
MRI / Vessel wall MRI (VW-MRI) - A 2025 review summarizes proposed VW-MRI signs (projection, “double lumen sign,” and contrast stasis) and reports improved detection compared with luminal imaging; reported detection advantages include intimal flap detection 42% vs 16% and threefold higher detection vs MRA in one cohort. (zedde2025carotidweban pages 9-10)
Key differentials explicitly listed in a recent review include: - Arterial dissection - Non-calcified atherosclerotic plaque - Intraluminal thrombus (zedde2025carotidweban pages 9-10)
A 2025 review reports high inter-modality agreement between CTA and DSA (e.g., CTA vs DSA κ≈0.92; CTA κ≈0.88 in summarized studies), with lower performance for ultrasound in some comparisons. (zedde2025carotidweban pages 9-10)
The following retrieved figure set shows multimodal ultrasound appearances of CaW and CaW with plaque (including SMI depiction of a thin triangular endoluminal defect), supporting real-world implementation of ultrasound-based recognition. (hou2024thedifferencesbetween media c303a27b, hou2024thedifferencesbetween media e72308b7, hou2024thedifferencesbetween media 6a447500)
CAROWEB tracks modified Rankin Scale (mRS) at 3–6 months, but the trial record excerpt does not provide quantitative outcome distributions. (NCT04431609 chunk 1)
A contemporary review states there are no randomized controlled trials for CaW therapy, and describes treatment options as medical therapy (single/dual antiplatelets; sometimes anticoagulation) versus intervention (CEA or CAS). (zedde2025carotidweban pages 1-2)
Observational literature summarized in a 2024 review indicates a ~10% annualized risk on medical therapy in symptomatic webs. (chen2024carotidwebsa pages 1-2)
No established primary prevention strategies specific to CaW were identified; CaW is not currently a target of population screening in standard guidelines based on the retrieved evidence.
Secondary prevention focuses on preventing recurrent embolic events in patients with diagnosed CaW, using antithrombotic therapy and/or definitive revascularization in selected cases, acknowledging the lack of RCTs. (zedde2025carotidweban pages 1-2)
No evidence of CaW as a naturally occurring disease model in non-human species was identified in the retrieved sources.
No established model organisms for CaW were identified in the retrieved sources.
| Domain | Key finding | Population/study design (n, setting) | Year | Source (journal/registry) | Identifier (DOI or NCT) | URL |
|---|---|---|---|---|---|---|
| Definition | Carotid web defined on CTA as a thin intraluminal filling defect along the posterior wall of the carotid bulb just beyond the bifurcation, seen as a septum on axial CTA (choi2015carotidwebsand pages 1-3) | Prospective + retrospective hospital-based imaging series; retrospective denominator 576 CTA/MRI patients | 2015 | American Journal of Neuroradiology | DOI: 10.3174/ajnr.a4431 | https://doi.org/10.3174/ajnr.a4431 |
| Definition | Carotid web described as a fibrous, shelf-like intimal flap from the posterior wall of the ICA bulb; review notes overall incidence largely unknown (chen2024carotidwebsa pages 1-2) | Narrative review of observational literature | 2024 | Journal of NeuroInterventional Surgery | DOI: 10.1136/jnis-2023-021243 | https://doi.org/10.1136/jnis-2023-021243 |
| Definition | Carotid web defined as intimal fibromuscular dysplasia with a shelf-like projection of intimal fibrous tissue into the carotid bulb (hou2024thedifferencesbetween pages 1-3) | Retrospective imaging cohort n=299 diagnosed by CTA or HRMRI and evaluated by multimodal ultrasound | 2024 | Insights into Imaging | DOI: 10.1186/s13244-024-01650-7 | https://doi.org/10.1186/s13244-024-01650-7 |
| Definition / pathology | Review states carotid web was historically described as an atypical FMD subtype with pathological evidence supporting intimal FMD (zedde2025carotidweban pages 9-10) | Narrative review of pathology/imaging/therapy literature | 2025 | Journal of Stroke | DOI: 10.5853/jos.2025.00626 | https://doi.org/10.5853/jos.2025.00626 |
| Epidemiology | Hospital-based period prevalence 7/576 = 1.2% (95% CI 0.4%–2.5%) (choi2015carotidwebsand pages 1-3) | Retrospective hospital series with baseline head/neck CTA followed by brain MRI | 2015 | American Journal of Neuroradiology | DOI: 10.3174/ajnr.a4431 | https://doi.org/10.3174/ajnr.a4431 |
| Epidemiology | Prospective series mean age 50 years (range 41–55); 5/7 women (71.4%) (choi2015carotidwebsand pages 1-3) | Prospective single-center case series n=7 | 2015 | American Journal of Neuroradiology | DOI: 10.3174/ajnr.a4431 | https://doi.org/10.3174/ajnr.a4431 |
| Epidemiology | Review table reports prevalence estimates of <1% in total population and 13% among patients with stroke of otherwise unknown etiology (chen2024carotidwebsa pages 1-2) | Review of published observational studies | 2024 | Journal of NeuroInterventional Surgery | DOI: 10.1136/jnis-2023-021243 | https://doi.org/10.1136/jnis-2023-021243 |
| Epidemiology | Cryptogenic stroke association reported range 2.5%–37%; conservative-therapy recurrence range 11.4%–27.3% (hou2024thedifferencesbetween pages 1-3) | Review statements within retrospective multimodal ultrasound cohort paper | 2024 | Insights into Imaging | DOI: 10.1186/s13244-024-01650-7 | https://doi.org/10.1186/s13244-024-01650-7 |
| Epidemiology | Systematic review pooled 771 patients from 123 articles (registry/cohort 559; case series/reports 212); higher prevalence reported in younger patients, females, and Afro-Caribbean individuals (ahmad2025carotidwebsa pages 1-3) | PRISMA systematic review | 2025 | Journal of Vascular Societies Great Britain & Ireland | DOI: 10.54522/jvsgbi.2025.164 | https://doi.org/10.54522/jvsgbi.2025.164 |
| Recurrence | Recurrent stroke occurred in 5/7 (71.4%); time to recurrence 1–97 months (choi2015carotidwebsand pages 1-3) | Prospective case series n=7 | 2015 | American Journal of Neuroradiology | DOI: 10.3174/ajnr.a4431 | https://doi.org/10.3174/ajnr.a4431 |
| Recurrence / treatment | Review reports symptomatic carotid webs have recurrence rates as high as 20% over 2 years (chen2024carotidwebsa pages 1-2) | Narrative review of observational data | 2024 | Journal of NeuroInterventional Surgery | DOI: 10.1136/jnis-2023-021243 | https://doi.org/10.1136/jnis-2023-021243 |
| Treatment | Review table reports annualized stroke risk on medical therapy ~10%, versus 0% after carotid stenting and 0% after endarterectomy in summarized observational literature (chen2024carotidwebsa pages 1-2) | Review of published observational studies | 2024 | Journal of NeuroInterventional Surgery | DOI: 10.1136/jnis-2023-021243 | https://doi.org/10.1136/jnis-2023-021243 |
| Treatment | Review cites pooled comparison: 0 recurrent strokes in 138 interventionally treated patients vs 26.8% recurrent cerebral ischemia in 151 medically treated patients; authors caution data are heterogeneous and potentially biased (zedde2025carotidweban pages 9-10) | Narrative review pooling observational cohorts | 2025 | Journal of Stroke | DOI: 10.5853/jos.2025.00626 | https://doi.org/10.5853/jos.2025.00626 |
| Pathophysiology | CFD study found CaW patients had significantly larger regions of low shear rate, high oscillatory shear index, low velocity, and flow stasis than mild atherosclerosis or normal bifurcations (sayed2024subjectswithcarotid pages 1-2) | Patient-specific CFD using CTA geometries + 2D phase-contrast MRI inflow; CaW n=13, mild atherosclerosis n=7, healthy n=6 | 2024 | Scientific Reports | DOI: 10.1038/s41598-024-60666-7 | https://doi.org/10.1038/s41598-024-60666-7 |
| Pathophysiology | Review summarizes thrombogenic mechanism as disturbed flow with stasis in the web pouch causing artery-to-artery embolism; pathology has identified small thrombi embedded in the web pouch (zedde2025carotidweban pages 9-10) | Narrative review of pathology and hemodynamic literature | 2025 | Journal of Stroke | DOI: 10.5853/jos.2025.00626 | https://doi.org/10.5853/jos.2025.00626 |
| Diagnostics | CTA is emphasized as primary acute diagnostic tool; diagnosis often requires concordance of 2 non-invasive modalities, with DSA reserved for diagnostic uncertainty/intervention planning (zedde2025carotidweban pages 9-10) | Narrative review | 2025 | Journal of Stroke | DOI: 10.5853/jos.2025.00626 | https://doi.org/10.5853/jos.2025.00626 |
| Diagnostics | VW-MRI diagnostic proposal includes thickness, posterior projection, “value sign,” “double lumen sign,” and contrast stasis; one cohort showed 3-fold higher detection than MRA, and intimal flaps were seen in 42% of dissections vs 16% by luminal techniques (zedde2025carotidweban pages 9-10) | Narrative review summarizing imaging studies | 2025 | Journal of Stroke | DOI: 10.5853/jos.2025.00626 | https://doi.org/10.5853/jos.2025.00626 |
| Diagnostics | Multimodal ultrasound/clinical cohort included 299 patients, mean age 60.85 ± 8.77 years; web length independently predicted luminal stenosis in isolated CW, while luminal stenosis and plaque length predicted symptoms in CW with plaque (hou2024thedifferencesbetween pages 1-3) | Retrospective cohort; CTA or HRMRI diagnosis plus CEUS and SMI from 2015–2022 | 2024 | Insights into Imaging | DOI: 10.1186/s13244-024-01650-7 | https://doi.org/10.1186/s13244-024-01650-7 |
| Trial / registry | Prospective multicenter registry comparing ischemic recurrences by preventive treatment; target enrollment 100; adults with stroke/TIA and CW diagnosed by angioCT, angioMRI, or arteriography; includes optional genetic polymorphism analysis (NCT05475080 chunk 1) | Multicenter prospective observational registry | 2022 | ClinicalTrials.gov | NCT05475080 | https://clinicaltrials.gov/study/NCT05475080 |
| Trial / registry | CAROWEB French multicenter prospective registry; target enrollment 300; adults with validated carotid web and downstream cerebral infarction/TIA; outcomes include imaging phenotype, management, mRS, bleeding, and recurrence (NCT04431609 chunk 1) | National prospective observational cohort/registry | 2019 | ClinicalTrials.gov | NCT04431609 | https://clinicaltrials.gov/study/NCT04431609 |
| Trial / familial | Family-WEB pilot screens first-degree relatives of index cases; estimated enrollment 90; aims to determine prevalence of carotid web in relatives by Doppler ultrasound, motivated by possible familial/genetic contribution (NCT06336083 chunk 1) | Single-center screening study | 2024 | ClinicalTrials.gov | NCT06336083 | https://clinicaltrials.gov/study/NCT06336083 |
| Trial / prevalence | CaWY cross-sectional survey estimates point prevalence in ages 15–25 by duplex sonography; planned sample 829 (minimum calculated 753); hypothesis prevalence ~2%; includes CTA validation subset (NCT07495241 chunk 1, NCT07495241 chunk 2) | Multicenter population-based cross-sectional cohort | 2026 | ClinicalTrials.gov | NCT07495241 | https://clinicaltrials.gov/study/NCT07495241 |
| Trial / incidence | Completed retrospective cohort, enrollment 31, designed to determine carotid web incidence, radiologic classification, and relationship with ischemic stroke/TIA using CTA and/or DSA (NCT06058507 chunk 1) | Retrospective observational cohort | 2022 | ClinicalTrials.gov | NCT06058507 | https://clinicaltrials.gov/study/NCT06058507 |
Table: This table compiles the main quantitative findings, standard definitions, diagnostic features, treatment outcomes, and active registry/trial characteristics for carotid web from the cited evidence. It is useful as a quick reference for building a structured disease knowledge base entry.
References
(chen2024carotidwebsa pages 1-2): Huanwen Chen, Marco Colasurdo, Matias Costa, Erez Nossek, and Peter Kan. Carotid webs: a review of pathophysiology, diagnostic findings, and treatment options. Journal of NeuroInterventional Surgery, 16:1294-1298, Jan 2024. URL: https://doi.org/10.1136/jnis-2023-021243, doi:10.1136/jnis-2023-021243. This article has 39 citations and is from a domain leading peer-reviewed journal.
(sayed2024subjectswithcarotid pages 1-2): Retta El Sayed, Carissa J. Lucas, Hannah L. Cebull, Fadi B. Nahab, Diogo C. Haussen, Jason W. Allen, and John N. Oshinski. Subjects with carotid webs demonstrate pro-thrombotic hemodynamics compared to subjects with carotid atherosclerosis. Scientific Reports, May 2024. URL: https://doi.org/10.1038/s41598-024-60666-7, doi:10.1038/s41598-024-60666-7. This article has 13 citations and is from a peer-reviewed journal.
(zedde2025carotidweban pages 9-10): Marialuisa Zedde, Maria Simona Stoenoiu, Alexandre Persu, and Rosario Pascarella. Carotid web: an update focusing on its relationship with fibromuscular dysplasia and therapeutic strategy. Journal of Stroke, 27:169-183, May 2025. URL: https://doi.org/10.5853/jos.2025.00626, doi:10.5853/jos.2025.00626. This article has 7 citations and is from a domain leading peer-reviewed journal.
(choi2015carotidwebsand pages 1-3): P.M.C. Choi, D. Singh, A. Trivedi, E. Qazi, D. George, J. Wong, A.M. Demchuk, M. Goyal, M.D. Hill, and B.K. Menon. Carotid webs and recurrent ischemic strokes in the era of ct angiography. American Journal of Neuroradiology, 36:2134-2139, Nov 2015. URL: https://doi.org/10.3174/ajnr.a4431, doi:10.3174/ajnr.a4431. This article has 273 citations and is from a peer-reviewed journal.
(NCT04442074 chunk 2): Characteristics in Doppler Ultrasound of the Carotid Diaphragm Responsible for an Ischemic Stroke. Fondation Hôpital Saint-Joseph. 2020. ClinicalTrials.gov Identifier: NCT04442074
(ahmad2025carotidwebsa pages 1-3): M. Ahmad, M. Tan, M. Abuarqoub, K. Patel, F. Siracusa, J. Shalhoub, and A. Davies. Carotid webs: a review of diagnosis and management strategies in current literature. Journal of Vascular Societies Great Britain & Ireland, 4:99-110, Feb 2025. URL: https://doi.org/10.54522/jvsgbi.2025.164, doi:10.54522/jvsgbi.2025.164. This article has 2 citations.
(NCT04431609 chunk 1): Carotid Web Associated With Cerebral Infarctions. University Hospital, Bordeaux. 2019. ClinicalTrials.gov Identifier: NCT04431609
(zedde2025carotidweban pages 1-2): Marialuisa Zedde, Maria Simona Stoenoiu, Alexandre Persu, and Rosario Pascarella. Carotid web: an update focusing on its relationship with fibromuscular dysplasia and therapeutic strategy. Journal of Stroke, 27:169-183, May 2025. URL: https://doi.org/10.5853/jos.2025.00626, doi:10.5853/jos.2025.00626. This article has 7 citations and is from a domain leading peer-reviewed journal.
(chen2024carotidwebsa pages 1-1): Huanwen Chen, Marco Colasurdo, Matias Costa, Erez Nossek, and Peter Kan. Carotid webs: a review of pathophysiology, diagnostic findings, and treatment options. Journal of NeuroInterventional Surgery, 16:1294-1298, Jan 2024. URL: https://doi.org/10.1136/jnis-2023-021243, doi:10.1136/jnis-2023-021243. This article has 39 citations and is from a domain leading peer-reviewed journal.
(khan2024in‐hospitalrecurrentstroke pages 1-2): Farhan Khan, Narendra Kala, Kelvin Chang, Liqi Shu, Eric D. Goldstein, Radmehr Torabi, Krisztina Moldovan, Mahesh Jayaraman, Nahid Mohammadzadeh, Karen Furie, and Shadi Yaghi. In‐hospital recurrent stroke in ipsilateral carotid web patients undergoing thrombectomy. Annals of Clinical and Translational Neurology, 11:2450-2456, Aug 2024. URL: https://doi.org/10.1002/acn3.52161, doi:10.1002/acn3.52161. This article has 10 citations and is from a peer-reviewed journal.
(ahmad2025carotidwebsa pages 3-4): M. Ahmad, M. Tan, M. Abuarqoub, K. Patel, F. Siracusa, J. Shalhoub, and A. Davies. Carotid webs: a review of diagnosis and management strategies in current literature. Journal of Vascular Societies Great Britain & Ireland, 4:99-110, Feb 2025. URL: https://doi.org/10.54522/jvsgbi.2025.164, doi:10.54522/jvsgbi.2025.164. This article has 2 citations.
(hou2024thedifferencesbetween pages 1-3): Chao Hou, Shuo Li, Lei Zhang, Wei Zhang, and Wen He. The differences between carotid web and carotid web with plaque: based on multimodal ultrasonic and clinical characteristics. Insights into Imaging, Mar 2024. URL: https://doi.org/10.1186/s13244-024-01650-7, doi:10.1186/s13244-024-01650-7. This article has 7 citations and is from a peer-reviewed journal.
(ahmad2025carotidwebsa pages 12-13): M. Ahmad, M. Tan, M. Abuarqoub, K. Patel, F. Siracusa, J. Shalhoub, and A. Davies. Carotid webs: a review of diagnosis and management strategies in current literature. Journal of Vascular Societies Great Britain & Ireland, 4:99-110, Feb 2025. URL: https://doi.org/10.54522/jvsgbi.2025.164, doi:10.54522/jvsgbi.2025.164. This article has 2 citations.
(NCT05475080 chunk 1): Carotid Web and Stroke Registry.. Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau. 2022. ClinicalTrials.gov Identifier: NCT05475080
(NCT06336083 chunk 1): Familial Form of Carotid Web: a Doppler Ultrasound Study. University Hospital, Toulouse. 2024. ClinicalTrials.gov Identifier: NCT06336083
(zedde2025carotidweban pages 3-5): Marialuisa Zedde, Maria Simona Stoenoiu, Alexandre Persu, and Rosario Pascarella. Carotid web: an update focusing on its relationship with fibromuscular dysplasia and therapeutic strategy. Journal of Stroke, 27:169-183, May 2025. URL: https://doi.org/10.5853/jos.2025.00626, doi:10.5853/jos.2025.00626. This article has 7 citations and is from a domain leading peer-reviewed journal.
(hou2024thedifferencesbetween media c303a27b): Chao Hou, Shuo Li, Lei Zhang, Wei Zhang, and Wen He. The differences between carotid web and carotid web with plaque: based on multimodal ultrasonic and clinical characteristics. Insights into Imaging, Mar 2024. URL: https://doi.org/10.1186/s13244-024-01650-7, doi:10.1186/s13244-024-01650-7. This article has 7 citations and is from a peer-reviewed journal.
(hou2024thedifferencesbetween media e72308b7): Chao Hou, Shuo Li, Lei Zhang, Wei Zhang, and Wen He. The differences between carotid web and carotid web with plaque: based on multimodal ultrasonic and clinical characteristics. Insights into Imaging, Mar 2024. URL: https://doi.org/10.1186/s13244-024-01650-7, doi:10.1186/s13244-024-01650-7. This article has 7 citations and is from a peer-reviewed journal.
(hou2024thedifferencesbetween media 6a447500): Chao Hou, Shuo Li, Lei Zhang, Wei Zhang, and Wen He. The differences between carotid web and carotid web with plaque: based on multimodal ultrasonic and clinical characteristics. Insights into Imaging, Mar 2024. URL: https://doi.org/10.1186/s13244-024-01650-7, doi:10.1186/s13244-024-01650-7. This article has 7 citations and is from a peer-reviewed journal.
(NCT07495241 chunk 1): Vendula Krcmarova. Prevalence of Carotid Web in Youth. University of Ostrava. 2026. ClinicalTrials.gov Identifier: NCT07495241
(NCT06058507 chunk 1): Ekin Öykü Baylam Yirmibeş. "Carotid Web Incidence and Radiological Classification, Determination of Its Relationship With Ischemic Stroke". Suleyman Demirel University. 2022. ClinicalTrials.gov Identifier: NCT06058507
(NCT07495241 chunk 2): Vendula Krcmarova. Prevalence of Carotid Web in Youth. University of Ostrava. 2026. ClinicalTrials.gov Identifier: NCT07495241