Beyond Limb Ischemia Thromboembolic Stroke as the Sentinel Manifestation of Cervical Rib Associated Arterial Thoracic Outlet Syndrome

Arterial thoracic outlet syndrome (aTOS) is a rare cause of ischemic stroke in young adults. We report a 21-year-old professional handball player with retrograde thromboembolic right middle cerebral artery infarction secondary to cervical rib-associated aTOS with chronic subclavian artery thrombosis and aneurysmal degeneration. The patient underwent thoracic outlet decompression with cervical and first rib resection followed by autogenous great saphenous vein bypass reconstruction. At 1-year follow-up, the graft remained patent without recurrent neurological or upper-limb ischemic events. Early recognition, vascular imaging, and definitive decompression with arterial reconstruction may prevent recurrent cerebral and upper-limb embolic events.