Thin Fluttering Bands: New Findings in the Carotid Evaluation

The aim of this study was to investigate the prevalence, characteristics, and possible clinical impact of the thin fluttering bands detected by carotid ultrasound. This is a prospective, observational study carried out in a single center between 2016 and 2018. A thin fluttering band was defined as a hyperechoic fluttering band detected by ultrasound in the carotid lumen in absence of findings compatible with pattern of dissection. Intraobserver and interobserver variability were carried out. A total of 3440 patients (p) were evaluated by carotid ultrasound, and thin fluttering bands were detected in 118 p (prevalence of 3.43%). The mean age was 58.9 ± 8.5 years and 48 p (40.7%) were male. In total, 97.5% of patients had no symptoms or neurological history. A total of 134 thin fluttering bands were identified (1.13 TFB/p; 104 p with 1 thin fluttering band, 12 p with 2 thin fluttering bands, and 2 p with 3 thin fluttering bands), and 83% of them were visualized from both longitudinal and transversal ultrasound views. Seventy-seven (57.5%) thin fluttering bands were localized on the right side, with the carotid bifurcation as the most common location (127 thin fluttering bands, 94.8%). The mean length of the bands was 5.6 ± 2.6 mm, with no significant differences in size according to the location, intima media thickness, or presence of carotid plaques. No significant interobserver and intraobserver variability was found. In conclusion, we have presented patients with thin fluttering bands, observing a significant prevalence in our population and ruling out a visual artifact. Their relationship with the genesis of atheroma plaques or its possible neurologic impact remains unclear.