Imaging and clinical features of cervical artery web: report of 41 cases and literature review

This study investigated the imaging and clinical features of cervical artery web to improve disease diagnosis. Imaging and clinical data of 41 patients with cervical artery web were retrospectively analyzed and summarized in the context of the literature. Of the 8653 patients who underwent carotid computed tomography angiography (CTA) in the past 3 years at our hospital, 41 (0.47%) were diagnosed with cervical artery web. Among the 41 patients, there were 38 web structures in typical position, including 26 web structures located in the internal carotid artery and 12 in the proximal bifurcation of the common carotid artery. And the other three web structures were located outside carotid artery, including two in the subclavian artery and one in the vertebral artery. There were 47 web structures in 41 cases of cervical artery web; 35/41 (85.3%) were unilateral and 6/41 (14.7%) were bilateral. Among 41 patients, there were 20 patients who had cerebral infarction, 14 who experienced transient ischemic attack, 3 patients with cerebral hemorrhage; and 4 with other manifestations. Cervical artery web showed typical imaging features in the carotid CTA. Cervical artery web was most common in the internal carotid artery and at the bifurcation of the common carotid artery. It was also occasionally found in other rare artery such as vertebral and subclavian artery. Based on the various locations of web structure, we think it is necessary to rename carotid web as cervical artery web. Most of the attachment sites of the web structures were located in the posterior wall of the lumen, followed by the lateral wall; sites on the anterior wall were rare. Cervical artery web may be an underappreciated risk factor for stroke. And hypertension can increase the incidence of ischemic stroke in patients with cervical artery web.