Incidental carotid webs in trauma patients

Carotid web (CaW) is notably prevalent among young patients with cryptogenic stroke. Data investigating its occurrence in asymptomatic individuals remains scarce. We evaluated the prevalence of CaWs in a cohort of trauma patients.

Cross sectional retrospective analysis of consecutive patients who underwent thin-cut neck CT angiograms between October 2015 and August 2018 at a Level 1 Trauma Center. The scans were independently reviewed by two fellowship-trained vascular neurologists who were blinded to demographics and clinical information, and all CaW were reviewed by a fellowship-trained neurointerventionist.

A total of 1157 CTAs in consecutive trauma patients were identified within the study period, and 998 were included. The median age was 39 years [IQR 27.0 - 55.0], 621 (61.3 %) were males, and 626 (62.7 %) were identified as Black or African Americans. 912 (91.4 %) patients had one CTA and 86 (8.6 %) patients had 2 or more CTAs available for review. 1320 (66.1 %) normal carotid bulbs were observed while 16 carotids were found to have a CaW (0.8 % of all carotids) in 15 patients (1.5 % of patients), in which 1 patient had bilateral webs. The lesion involved the postero-lateral carotid bulb wall in 46.7 % of cases, followed by posterior involvement in 33.3 %, postero-medial in 13.3 %, and anterior in 6.7 %. The mean web length was 2.6 ± 0.9 millimeters. Atherosclerotic lesions were otherwise identified in 484 carotid bulbs (24.2 % of all carotid arteries), affecting 394 patients (39.5 %) CONCLUSION: Incidental CaW were identified in 1.5 % of trauma patients undergoing CTA. Incidental CaW may be more common than previously recognized and underscore the need for further studies to determine its clinical relevance.