Lacunar stroke with incidental congenital absence of the internal carotid artery: importance of recognising a rare anatomical variant

We report a case of a woman in her 50s who presented with a left lacunar infarct and was incidentally found to have congenital absence of the ipsilateral internal carotid artery (ICA). This rare vascular anomaly was confirmed by the presence of a hypoplastic bony carotid canal on imaging, consistent with congenital origin. Cerebral perfusion was preserved, and no conventional vascular risk factors were identified. This case highlights the diagnostic importance of recognising congenital ICA absence on neurovascular imaging, particularly in stroke assessment, to prevent misinterpretation and to guide appropriate management.