Carotid Web-Associated Ischemic Stroke in a Young Woman: Diagnostic Pitfalls and Endovascular Management

Objective:Unknown etiology Background:Carotid web (CaW) is an uncommon intimal variant of fibromuscular dysplasia affecting the internal carotid artery (ICA) and is increasingly recognized as a cause of ischemic stroke in young and middle-aged patients without traditional vascular risk factors.The lesion is a thin, shelf-like fibrointimal projection arising from the carotid bulb that disrupts local hemodynamics and promotes thrombus formation and cerebral embolization.CaW is frequently underdiagnosed because of its subtle imaging appearance and limited clinical awareness. Case Report:A 40-year-old woman presented with sudden speech disturbances and right-sided weakness.Neurological examination revealed mixed aphasia and mild right hemiparesis (National Institutes of Health Stroke Scale score of 8).Computed tomography angiography (CTA) demonstrated distal branch occlusion of the left middle cerebral artery and an abnormal lesion at the left carotid bulb, suspected to represent CaW.As the intravenous thrombolysis window had elapsed, mechanical thrombectomy was performed, achieving complete reperfusion (modified Thrombolysis in Cerebral Infarction grade 3).Follow-up imaging confirmed left frontoparietal ischemic changes.Extensive diagnostic evaluation excluded other causes of stroke.Persistent carotid stenosis was identified during follow-up, and the patient subsequently underwent carotid angioplasty with stent implantation, restoring normal arterial lumen and cerebral blood flow.The postoperative course was uneventful, and she was discharged in good clinical condition. Conclusions:This case highlights the importance of considering CaW in the differential diagnosis of cryptogenic stroke in young patients.Advanced vascular imaging may facilitate timely diagnosis, while appropriate treatment may reduce recurrent cerebrovascular risk.Further studies are needed to define optimal diagnostic and therapeutic strategies for CaW.