Carotid web: an underrecognized cause of ischemic stroke in a young patient

Carotid web is an underdiagnosed cause of ischemic stroke, particularly in young and middle-aged patients without major atherosclerotic risk factors. It is characterized by a shelf-like intraluminal filling defect arising from the posterior wall of the carotid bulb, promoting thrombus formation through local hemodynamic disturbances. We report the case of a 45-year-old woman with a history of well-controlled hypertension who presented with acute right upper limb weakness. Brain imaging confirmed an acute ischemic stroke. CT angiography of the supra-aortic vessels demonstrated a carotid web at the left carotid bulb associated with a floating thrombus. No alternative embolic etiology was identified after a comprehensive cardiovascular and systemic evaluation. This case highlights the importance of considering a carotid web in cases of otherwise cryptogenic stroke, even in patients with well-controlled comorbidities. Early diagnosis is essential due to the high risk of recurrence, requiring timely and appropriate interventional management.