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Carotid web

Carotid web — Comprehensive Disease Characteristics Report

2026-05-05
Falcon MONDO:0979323 Model: Edison Scientific Literature 30 citations

Carotid web — Comprehensive Disease Characteristics Report

Target disease

  • Disease name: Carotid web (carotid artery web)
  • Category: Complex (vascular anomaly / non-atherosclerotic carotid arteriopathy associated with ischemic stroke)
  • MONDO ID: Not identified from the retrieved sources in this run (see “Key identifiers”).

Executive summary (current understanding; 2023–2024 emphasized)

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)

1. Disease information

1.1 What is the disease? (concise overview)

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)

1.2 Common synonyms / alternative names

1.3 Key identifiers (OMIM, Orphanet, ICD-10/ICD-11, MeSH, Mondo)

  • MONDO / MeSH / ICD coding: Not confirmed from the retrieved sources in this run. Carotid web is commonly discussed as an imaging-defined lesion and may be coded under broader carotid/artery anomaly or stenosis/disorder categories in clinical systems; however, a specific code could not be evidenced here.

1.4 Evidence source type

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)

2. Etiology

2.1 Disease causal factors (current hypotheses)

  • Non-atherosclerotic arteriopathy / intimal FMD phenotype: CaW is repeatedly described as an atypical FMD subtype with pathologic support for intimal fibroplasia/hyperplasia. (chen2024carotidwebsa pages 1-2, zedde2025carotidweban pages 1-2)
  • Potential congenital/developmental contribution: Reviews note debated pathogenesis with proposed developmental origins. (chen2024carotidwebsa pages 1-1)
  • Genetic and/or hormonal contributions (hypothesized, not established): A 2024 review notes “genetic predisposition or hormonal factors” may contribute, but evidence remains limited. (chen2024carotidwebsa pages 1-2)

2.2 Risk factors

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)

2.3 Protective factors

No protective genetic variants or protective environmental factors were identified in the retrieved sources.

2.4 Gene–environment interactions

No CaW-specific gene–environment interaction evidence was identified in the retrieved sources.

3. Phenotypes

3.1 Core clinical phenotypes (human)

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)

3.2 Phenotype characteristics (onset, severity, progression)

  • Onset pattern: Acute neurologic deficits due to ischemic stroke/TIA. (NCT04431609 chunk 1)
  • Severity: Can be severe; CAROWEB describes association with “severe cerebral infarction in the carotid territory.” (NCT04431609 chunk 1)
  • Course: High recurrence risk in symptomatic cases, including in-hospital recurrence after thrombectomy. (khan2024in‐hospitalrecurrentstroke pages 1-2)

3.3 Suggested HPO terms (examples for a knowledge base)

(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)

3.4 Quality-of-life impact

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)

4. Genetic / molecular information

4.1 Causal genes / pathogenic variants

No CaW-specific causal genes or pathogenic variants were identified from the retrieved primary/clinical literature in this run.

4.2 Evidence for genetic contribution (investigational)

  • Registry plans for polymorphism studies: A prospective CaW registry explicitly includes “detection of genetic polymorphisms associated with CW” as a secondary aim, indicating ongoing investigation rather than established genetics. (NCT05475080 chunk 1)
  • Familial screening study: Family-WEB (NCT06336083) screens first-degree relatives, motivated by epidemiologic signals and possible genetic contribution, while noting no established familial forms to date. (NCT06336083 chunk 1)

4.3 Epigenetics / molecular profiling / multi-omics

No CaW-specific epigenomic/transcriptomic/proteomic/metabolomic signatures were identified in the retrieved sources.

5. Environmental information

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)

6. Mechanism / pathophysiology

6.1 Causal chain (current mechanistic model)

  1. Anatomical lesion: A fibrous, shelf-like intimal flap/projection at the carotid bulb/proximal ICA (often posterior wall). (chen2024carotidwebsa pages 1-2, zedde2025carotidweban pages 9-10)
  2. Hemodynamic disturbance: The web creates disturbed flow with recirculation and stasis in the web pouch. (sayed2024subjectswithcarotid pages 1-2, chen2024carotidwebsa pages 1-2)
  3. Thrombogenesis: Stasis and abnormal shear promote thrombus formation; pathology-based reviews describe “small thrombi embedded in the web pouch.” (zedde2025carotidweban pages 1-2)
  4. Embolization: Thrombus fragments embolize intracranially, producing embolic ischemic stroke, including LVO events. (chen2024carotidwebsa pages 1-2, khan2024in‐hospitalrecurrentstroke pages 1-2)

6.2 Hemodynamics evidence (2024)

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)

6.3 Histopathology evidence (reviewed)

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)

6.4 Suggested ontology terms

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)

7. Anatomical structures affected

7.1 Organ/system level

  • Primary site: Extracranial carotid bifurcation / proximal ICA (posterior wall predilection emphasized in imaging/pathology reviews). (zedde2025carotidweban pages 9-10)
  • Secondary effect: Brain (ischemic infarction / LVO stroke) downstream of ipsilateral lesion. (khan2024in‐hospitalrecurrentstroke pages 1-2, NCT04431609 chunk 1)

7.2 Tissue/cell level

7.3 Subcellular

No CaW-specific subcellular compartment abnormalities were identified.

8. Temporal development

  • Onset: Often detected after acute ischemic stroke/TIA presentation; can be incidentally found on imaging. (NCT04431609 chunk 1, khan2024in‐hospitalrecurrentstroke pages 1-2)
  • Progression/course: The main clinically relevant temporal feature is risk of recurrence without definitive treatment; in-hospital recurrence after thrombectomy has been quantified (RR estimates). (khan2024in‐hospitalrecurrentstroke pages 1-2)

9. Inheritance and population

9.1 Epidemiology (key statistics)

  • General/hospital prevalence: A hospital-based retrospective series estimated period prevalence 1.2% (7/576; 95% CI 0.4–2.5%). (choi2015carotidwebsand pages 1-3)
  • Prevalence in cryptogenic stroke: Reviews summarize wide ranges; one 2024 imaging cohort review cites 2.5–37% prevalence in cryptogenic stroke literature. (hou2024thedifferencesbetween pages 1-3)
  • Young cryptogenic stroke enrichment: A 2024 review summarizes ~13% frequency among patients with stroke of otherwise unknown etiology and “young” patients with otherwise cryptogenic stroke. (chen2024carotidwebsa pages 1-1)

9.2 Demographics

9.3 Inheritance

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)

10. Diagnostics

10.1 Imaging modalities and diagnostic features

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)

10.2 Differential diagnosis

Key differentials explicitly listed in a recent review include: - Arterial dissection - Non-calcified atherosclerotic plaque - Intraluminal thrombus (zedde2025carotidweban pages 9-10)

10.3 Diagnostic performance (available quantitative metrics)

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)

10.4 Visual diagnostic exemplars

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)

11. Outcome / prognosis

11.1 Recurrence risk

  • A 2024 review summarizes symptomatic CaW recurrence rates up to ~20% over 2 years and reports an annualized stroke risk on medical therapy ~10% in summarized observational evidence. (chen2024carotidwebsa pages 1-1, chen2024carotidwebsa pages 1-2)
  • A 2024 thrombectomy cohort reported markedly increased in-hospital recurrence risk when an ipsilateral CaW was present (adjusted RR 4.38 for recurrent ischemic stroke; adjusted RR 4.49 for recurrent ipsilateral LVO). (khan2024in‐hospitalrecurrentstroke pages 1-2)

11.2 Functional outcomes

CAROWEB tracks modified Rankin Scale (mRS) at 3–6 months, but the trial record excerpt does not provide quantitative outcome distributions. (NCT04431609 chunk 1)

12. Treatment

12.1 Current practice (observational evidence; no RCTs)

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)

12.2 Medical therapy

Observational literature summarized in a 2024 review indicates a ~10% annualized risk on medical therapy in symptomatic webs. (chen2024carotidwebsa pages 1-2)

12.3 Carotid endarterectomy (CEA) and carotid artery stenting (CAS)

  • A 2024 review table summarizes 0% recurrent stroke risk after carotid stenting and 0% after endarterectomy in compiled observational series (recognizing limitations of small samples and selection). (chen2024carotidwebsa pages 1-2)
  • A 2025 review summarizing observational pooled data reports no recurrent strokes in interventionally treated patients versus 26.8% recurrent cerebral ischemia in medically treated patients, while cautioning heterogeneity and potential bias. (zedde2025carotidweban pages 9-10)

12.4 MAXO term suggestions (examples)

  • Antiplatelet therapy — MAXO:0000767
  • Anticoagulant therapy — MAXO:0000740
  • Carotid endarterectomy — (MAXO term for endarterectomy / carotid endarterectomy; map per MAXO catalog)
  • Carotid artery stenting — (MAXO term for endovascular stent placement)
  • Mechanical thrombectomy — (MAXO term for thrombectomy)

12.5 Real-world implementations / care pathways

  • Stroke centers: CaW is increasingly evaluated in young/cryptogenic/LVO stroke workups, and can influence decisions about secondary prevention or revascularization. (chen2024carotidwebsa pages 1-2, khan2024in‐hospitalrecurrentstroke pages 1-2)
  • Imaging practice: Use of CTA with multiplanar reconstructions, plus confirmatory modality concordance (e.g., CTA + ultrasound/VW-MRI) is emphasized. (zedde2025carotidweban pages 9-10)

12.6 Ongoing trials/registries (ClinicalTrials.gov)

  • CAROWEB registry (France): NCT04431609, prospective multicenter cohort/registry (start 2019-06-19; planned completion 2026-06-30) capturing imaging, management, mRS, and recurrence. (NCT04431609 chunk 1)
  • Carotid Web and Stroke Registry: NCT05475080 (start 2022-07-15; primary completion estimate 2024-07-15), compares recurrence by preventive treatment and includes genetic polymorphism investigation. (NCT05475080 chunk 1)
  • Familial screening: NCT06336083 (Family-WEB; start 2024-09-11), ultrasound screening of first-degree relatives. (NCT06336083 chunk 1)
  • Youth prevalence (population DUS): NCT07495241 (start 2026-01-04), estimates prevalence in ages 15–25; includes CTA validation subset. (NCT07495241 chunk 1)
  • Radiologic classification/incidence (completed): NCT06058507 (retrospective cohort; completion 2023-08-20). (NCT06058507 chunk 1)

13. Prevention

13.1 Primary prevention

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.

13.2 Secondary/tertiary prevention

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)

14. Other species / natural disease

No evidence of CaW as a naturally occurring disease model in non-human species was identified in the retrieved sources.

15. Model organisms

No established model organisms for CaW were identified in the retrieved sources.

Key quantitative findings table

Table (click to expand)
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.

Evidence gaps and expert interpretation

  1. No RCT-level evidence for treatment: Multiple authoritative reviews emphasize that management is based on observational cohorts/series and expert practice rather than randomized trials. (zedde2025carotidweban pages 1-2, zedde2025carotidweban pages 9-10)
  2. Highly variable prevalence estimates: Reported CaW prevalence depends strongly on case definition, imaging technique (including reconstruction planes), and selection of cryptogenic/LVO cohorts. (hou2024thedifferencesbetween pages 1-3, chen2024carotidwebsa pages 1-1)
  3. Genetics remains investigational: Ongoing registries and familial screening studies indicate a plausible genetic contribution, but causal genes/variants are not established in the retrieved clinical literature. (NCT05475080 chunk 1, NCT06336083 chunk 1)

URLs and publication dates (selected key sources)

References

  1. (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.

  2. (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.

  3. (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.

  4. (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.

  5. (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

  6. (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.

  7. (NCT04431609 chunk 1): Carotid Web Associated With Cerebral Infarctions. University Hospital, Bordeaux. 2019. ClinicalTrials.gov Identifier: NCT04431609

  8. (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.

  9. (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.

  10. (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.

  11. (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.

  12. (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.

  13. (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.

  14. (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

  15. (NCT06336083 chunk 1): Familial Form of Carotid Web: a Doppler Ultrasound Study. University Hospital, Toulouse. 2024. ClinicalTrials.gov Identifier: NCT06336083

  16. (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.

  17. (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.

  18. (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.

  19. (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.

  20. (NCT07495241 chunk 1): Vendula Krcmarova. Prevalence of Carotid Web in Youth. University of Ostrava. 2026. ClinicalTrials.gov Identifier: NCT07495241

  21. (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

  22. (NCT07495241 chunk 2): Vendula Krcmarova. Prevalence of Carotid Web in Youth. University of Ostrava. 2026. ClinicalTrials.gov Identifier: NCT07495241