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Author Notes:

Correspondence: Diogo C. Haussen diogo.haussen@emory.edu

eviewed by: Amit Kandel, University at Buffalo; Alicia C. Castonguay, University of Toledo

TM and DH: manuscript editing, drafting and reviewing, data analysis, and study design; RN, JG, CB, MF, and AA: manuscript editing and drafting, study reviewers.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Neurosciences
  • Neurosciences & Neurology
  • fibromuscular dysplasia
  • carotid web
  • stroke
  • diagnostic imaging
  • neuroradiology

Multimodality Imaging in Carotid Web


Journal Title:

Frontiers in Neurology


Volume 10


, Pages 220-220

Type of Work:

Article | Final Publisher PDF


Purpose: Carotid web (CaW) is an underrecognized cause of cryptogenic stroke in young patients. The optimal imaging for CaW is unknown. We aim to evaluate the diagnostic accuracy of diverse imaging modalities for the diagnosis of CaW. Methods: Retrospective analysis of institutional neurovascular database was performed to identify patients with multimodal (CT angiogram-CTA, digital subtraction angiogram-DSA, and/or ultrasound-US) imaging diagnosis of CaW or atherosclerosis. Baseline clinical demographics were recorded. Blinded image analysis was performed for each imaging modality by separate readers. Discrepancies were settled by consensus. Two-sided Cohen's Kappa (κ) coefficient was used to evaluate the inter-rater agreement for the etiological diagnosis between imaging modalities. Results: Thirty patients/60 carotids were evaluated by CTA and 55 carotids were included. Patients with symptomatic CaW (n = 20), compared to individuals with atherosclerosis (n = 10), were younger (49 ± 9 vs. 60 ± 8 years; p < 0.01), more commonly female (75% vs. 30%; p = 0.01), and less frequently presented vascular risk factors: Hypertension (40% vs. 100%; p < 0.01), hyperlipidemia (0% vs. 50%; p < 0.01), diabetes (10% vs. 40%; p = 0.05), and smoking (5% vs. 70%; p < 0.01). High inter-rater correlation strength existed for CTA (n = 55; κ = 0.88; p < 0.0001) and DSA (n = 28; κ = 0.86, p < 0.0001) readers for lesion diagnosis while US inter-rater agreement was lower (κ = 0.553; p = 0.001). Across modalities CTA and DSA shared very high strength of agreement (κ = 0.92; p < 0.0001), compared to a less pronounced agreement between US and CTA (κ = 0.553; p = 0.001). The strength of correlation between DSA-CTA was significantly more robust as compared to US-CTA (Z = 3.58; p = 0.0003). Conclusion: CTA and DSA demonstrated comparable and superior performance as compared to US in the diagnosis of CaW.

Copyright information:

© 2019 Madaelil, Grossberg, Nogueira, Anderson, Barreira, Frankel and Haussen.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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