Abstract 255: Carotid Web Prevalence in the General Population: Insights from a Trauma Center Cohort

Introduction Carotid web (CaW), a shelf‐like intimal hyperplastic lesion of the carotid bulb, is a frequently missed or misdiagnosed etiology of cryptogenic stroke, especially in younger patients without typical vascular risk factors. Despite recently increasing clinical interest and recognition, the prevalence of carotid web remains poorly defined. Because reported prevalence estimates typically include a large proportion of patients who present for stroke evaluation, generalizability is limited. This study aims to estimate the prevalence of CaW using patients undergoing Computerized Tomography Angiography (CTA) of the head and neck for trauma evaluation as a surrogate for the general population. Methods We retrospectively reviewed 400 consecutive head and neck CTAs performed at a Level 1 trauma center between September 2024 and December 2024. Eligible patients were aged 18‐65 undergoing CTA for trauma evaluation. Scans were screened by a board‐certified neurologist and senior neurology resident; suspected CaWs were independently reviewed by two endovascular neurologists and one endovascular neurosurgeon blinded to clinical data. Consensus of at least 2 specialists confirmed diagnosis. Descriptive statistics were used to calculate the point prevalence of CaW, and 95% confidence intervals (CIs) were estimated using the Wilson method. Subgroup analyses by age, sex, and race were performed. Interobserver agreement was assessed using Fleiss's kappa coefficient. Results Of the 400 patients, 56 were excluded (54 for poor‐quality scans, 2 for concomitant cervical fractures), leaving 344 scans to include in the analysis (mean age 39 ± 13.9; 66.8% male, 51.4% Black). CaW was identified in 7 patients, yielding a point prevalence of 2.0% (95% CI, 0.9‐4.1%). One patient (14.2%) had bilateral CaWs. Only 1 of 8 CaWs (12.5%) was diagnosed on the original radiology report. Prevalence did not differ significantly by sex (1.7% female vs 2.1% male, p =0.99) or race (2.2% Black vs 2.4% White, p =0.99). One patient (14.2%) was diagnosed with acute ischemic stroke ipsilateral to the side of the CaW during hospitalization. Interobserver agreement was fair (Fleiss's κ = 0.35). Conclusions In this cohort of patients undergoing CTA of the head and neck for trauma evaluation, the prevalence of carotid web was 2.0%. Only 12.5% of the carotid webs were diagnosed on the final radiology report. Larger prospective studies are warranted to validate these findings and assess clinical implications.