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Updated: Jul 10, 2026
A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Multimodal ultrasound-based morphological differences between symptomatic and asymptomatic carotid web
Chenyang Dai1,2,3,4, Shihao Ruan1,2,3,4, Linlin Li1
1Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Objective:
We aimed to investigate the differences between symptomatic and asymptomatic carotid webs (CWs) using clinical and ultrasound morphological features and identify potential risk factors for CW-associated ischemic stroke.
Methods:
We retrospectively recruited 45 patients diagnosed with CW between January 2021 and September 2024 using digital subtraction angiography or computed tomography angiography. Patients were categorized according to the occurrence of CW-associated stroke. Multimodal ultrasound was used to identify the morphological characteristics of the CWs, carotid stenosis rate and hemodynamic alterations. Binary-variable logistic regression was used to assess the high-risk ultrasound morphologic features of CW-induced ischemic stroke.
Results:
Forty-five patients with CWs were identified, of whom 15 had stroke-related symptomatic CWs. Symptomatic patients demonstrated higher hyperlipidemia prevalence, had greater web dimensions (length, 5.80 ± 1.64 vs. 4.41 ± 1.67 mm, p = 0.011; thickness, 1.88 ± 0.43 vs. 1.38 ± 0.39 mm, p < 0.001), and a higher prevalence of curved CW shape (80.0% vs. 43.3%, p = 0.044). CW-induced stenosis was more severe in the symptomatic group than in the asymptomatic group (46.35 ± 9.89% vs. 40.13 ± 11.44%), although the majority of the stenoses were mild (<50%). Hemodynamically, while flow velocities were comparable, symptomatic cases showed significantly lower resistance index (0.59 ± 0.10 vs. 0.65 ± 0.07, p = 0.02). Multivariate analysis identified CW length (OR = 2.10, 95% CI 1.08-4.06; p = 0.028), CW thickness (OR = 21.80, 95% CI 2.43-196.00; p = 0.006), and lower RI as independently associated factors of symptomatic CWs. ROC analysis yielded optimal cutoffs of >1.65 mm for thickness (AUC = 0.813), > 5.20 mm for length (AUC = 0.723), and ≤ 0.691 for RI (AUC = 0.698).
Conclusion:
Symptomatic CWs exhibit distinct morphological and hemodynamic features than asymptomatic CWs. These ultrasound-detectable characteristics may help identify high-risk patients for stroke prevention.
