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Original research
Optical Coherence Tomography in the Evaluation of Suspected Carotid Webs
  1. Alhamza R Al-Bayati1,2,
  2. Raul G Nogueira1,2,
  3. Rajesh Sachdeva3,
  4. Mahmoud H Mohammaden2,
  5. Nirav R Bhatt1,2,
  6. Bernardo Liberato2,
  7. Michael R Frankel2,
  8. Diogo C Haussen2
  1. 1Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA
  2. 2Neurology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA
  3. 3Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Diogo C Haussen, Neurology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA; diogo.haussen{at}


Background Carotid web (CaW) is a subtype of fibromuscular dysplasia that predominantly involves the intimal layer of the arterial wall and is commonly overlooked as a separate causative entity for recurrent strokes. CaW is defined as a shelf-like lesion at the carotid bulb, although different morphological features have been reported. Optical coherence tomography (OCT) has been described in the literature as a useful microscopic and cross-sectional tomographic imaging tool. This study aimed to evaluate the potential utility of OCT in characterizing the wall structure features of patients with suspected CaW.

Methods Retrospective analysis of patients with suspected CaW who underwent digital subtraction angiography (DSA) coupled with OCT of the carotid bulb from 2018 to 2021 in a single comprehensive stroke center.

Results Sixteen patients were included. The median age was 56 years (IQR 46–61) and 50% were women. OCT corroborated the diagnosis of CaW in 12/16 (75%) cases and ruled it out in 4/16 (25%) patients in whom atherosclerotic disease was demonstrated. Five of the 12 lesions demonstrated a thick fibrotic ridge consistent with CaW but also showed atherosclerotic changes in the vicinity of the carotid bulb (labeled as “CaW+”). In 4/16 (25%) patients, microthrombi adhered to the vessel wall were noted on OCT (inside the CaW pocket or just distal to the web), none of which were observed on CT angiography or DSA.

Conclusions OCT may have value as a complementary imaging tool in the investigation of patients with suspected CaW and atypical morphological features. Further studies are warranted.

  • Angiography
  • Cervical
  • Plaque
  • Stent
  • Vessel Wall

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @AlAlBayati1, @Mahmoudneuro, @nirav_r_bhatt, @diogohaussen

  • Contributors ARA, DCH, RGN, and RS: data acquisition. ARA, DCH, and RS: interpretation of the results. ARA: manuscript drafting. DCH: study concept; responsible for study findings. All authors: critical revision of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.