The Carotid Web as a Cause of Cryptogenic Stroke in a Young Patient: Diagnosis and Treatment

Carotid Webs (CWs) are rare, non-atherosclerotic intraluminal abnormalities increasingly recognized as a potential cause of ischemic stroke, particularly in young adults without traditional vascular risk factors.We report the case of a 48-year-old man with no significant medical history, who presented with sudden-onset left hemiplegia and dysarthria.Brain imaging revealed a complete right middle cerebral artery infarction.Extensive etiological workup was unremarkable.Vascular imaging identified a thin, linear defect in the posterior wall of the right carotid bulb, consistent with a carotid web.The patient partially recovered with supportive care, was started on oral anticoagulation, and referred for vascular surgery.CWs are often asymptomatic until they cause embolic strokes.They are underdiagnosed and may be responsible for a significant proportion of cryptogenic strokes.Diagnosis is primarily based on cervical CT angiography, while MRI and Doppler ultrasound may lack sensitivity.Given the high risk of recurrence, particularly in the same vascular territory, more definitive treatment options such as surgical endarterectomy or carotid artery stenting should be considered.Carotid webs should be included in the differential diagnosis of cryptogenic stroke, especially in younger patients.Timely recognition through appropriate imaging and multidisciplinary management is essential to prevent recurrence.