Abstract Background and aims Carotid web (CaW) is a thin, shelf-like, triangular projection in the internal carotid artery linked to embolic stroke, especially in young adults. Its prevalence and long-term outcome in older adults are unknown. This study aimed to determine the prevalence of CaW among individuals aged 50 years and their 10-year stroke risk. Methods Three experienced sonographers evaluated videos and images of carotid arteries from baseline, 3-, 6-, and 10-year duplex sonographic examinations of patients enrolled in the ANTIQUE study (ClinicalTrials ID:NCT02360137). All eccentric lesions at the carotid bifurcation were selected and reevaluated into four groups: definite CaW, suspected CaW, atherosclerotic plaque, and artifact. At least two sonographers had to agree on the classification. TIA/stroke and vascular/all-cause mortality were recorded during 10-year follow-up. Results 1,652 patients (749 males; age 68.7±9.4 years) were included in the analysis. Among 130 patients with the eccentric lesions, 3 (0.18%) were classified as definite CaW, 62 (3.75%) as suspected CaW, and 57 as atherosclerotic plaques. Patients with definite/suspected CaW more often experienced ipsilateral TIA/stroke than those with eccentric carotid plaques (10.8% vs. 3.5%; p0.05), but no differences were seen in TIA/stroke in other territories (7.7% vs. 7.0%; p0.05) or in vascular/all-cause mortality (10.8/24.6% vs. 26.3/12.3%; p0.05). Conclusions Prevalence of CaW in individuals aged 50 years with carotid atherosclerosis was 3.9%. These patients had significantly higher risk of ipsilateral stroke than those with eccentric plaques. Careful ultrasound differentiation of CaW from eccentric atherosclerotic plaque may improve stroke risk stratification in older patients. Conflict of interest István Szegedi: nothing to disclose. David Školoudík: nothing to disclose. David Pakizer: nothing to disclose.
Szegedi et al. (2026) studied this question.