Angiographic string sign

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contributed by Behrang Amini, MD/PhD on May 2, 2008

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The angiographic string sign, also known as the carotid string sign, refers to the thin string of intravenous contrast material distal to a stenotic focus in the internal carotid artery (ICA). This thin stripe of flow is caused by decreased pressure distal to the stenosis, which causes collapse of the distal ICA.

An angiographic string sign may be caused by

  • Preocclusive atherosclerosis at the carotid bifurcation
  • ICA dissection
  • ICA thrombosis
    • Subacute partial
    • Chronic subtotal
  • Partial recanalization of an occluded ICA

Imaging differential diagnosis

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