ABSTRACT NUMBER: ESOC2026A2306 CAROTID WEB AND STROKE IN YOUNG ADULTS: MULTIMODALITY IMAGING DIAGNOSIS AND TREATMENT INSIGHTS IN A EMERGING COUNTRY

Abstract Background and aims Carotid web is a treatable, underdiagnosed etiology of ischemic stroke in young adults, with a high recurrence rate (29%). Digital subtraction angiography (DSA) and computed tomographic angiography (CTA) seem to have comparable diagnostic accuracy. However, the best management remains unclear. We evaluated the presence of CaW among young stroke patients at a tertiary university hospital in Brazil using multimodality imaging techniques. Methods Prospective data were collected from patients presenting from October 2018 to November 2025 at a comprehensive Brazilian stroke center and were retrospectively reviewed. Results Among 2,400 patients admitted with stroke, 25 were CaW-related (60% female, mean age 51 years). All patients had a baseline mRS of 0. All strokes were ischemic (40% in the left hemisphere). Almost one-fifth of patients had bilateral carotid web. All patients underwent CTA, 52% DSA, 60% ultrasound, and 52% magnetic resonance imaging. The median NIHSS was 9 and ASPECTS was 10. Regarding treatment, 80% received aspirin and 40% underwent angioplasty. At discharge, the median NIHSS was 1 and mRS was 1. Conclusions Although carotid web represents a treatable cause of stroke in the young, data are still scarce, especially in emerging countries. CTA is the most widely used imaging modality, and revascularization may constitute a viable treatment option. Conflict of interest Leticia Escorse Requiao. Nothing to disclose.