Carotid webs (CaWs) are rare, fibromuscular dysplasia-like intimal flaps that originate from the posterior wall of the internal carotid bulb and project into the arterial lumen. They are associated with ischemic stroke, particularly in young patients without other stroke risk factors, and may recur in up to 20% of cases within two years. Despite their clinical significance, there are no clear guidelines for managing CaWs. This review discusses the epidemiology, pathogenesis, pathophysiology, diagnosis, and treatment options for CaWs. CaWs are characterized by focal intimal hyperplasia, distinct from classic fibromuscular dysplasia and atherosclerosis. They are more common in younger individuals, African Americans, and females. CaWs are associated with altered blood flow and stasis, promoting thrombogenesis and increasing the risk of embolic strokes. The size and morphology of CaWs are linked to stroke risk, with larger and more acute-angled CaWs being more likely to cause strokes. Diagnosis of CaWs involves imaging modalities such as CTA, MR angiography, ultrasound, and catheter angiography. CTA is the most widely used, but CaWs are often missed in real-world practice. Multiplanar reconstructions are essential for accurate diagnosis. MR angiography and vessel wall imaging can also detect CaWs, while ultrasound is less reliable due to lower resolution. Intravascular ultrasound and optical coherence tomography are emerging tools for better characterization. Treatment options include carotid stenting and carotid endarterectomy. Stenting has shown high efficacy in preventing recurrent strokes, with no major complications in studies. Carotid endarterectomy is also effective, with no perioperative complications in case series. Both procedures are generally safe, with low complication rates compared to historical data for carotid interventions. While medical management with antiplatelet therapy is used, it may not be sufficient to prevent stroke recurrence. Carotid interventions are recommended for symptomatic CaWs, particularly in patients with a high risk of recurrence. Future studies are needed to compare the efficacy of stenting and endarterectomy and to optimize treatment strategies based on CaW size and morphology. The choice between stenting and endarterectomy depends on patient factors, proceduralist experience, and individual anatomical features.Carotid webs (CaWs) are rare, fibromuscular dysplasia-like intimal flaps that originate from the posterior wall of the internal carotid bulb and project into the arterial lumen. They are associated with ischemic stroke, particularly in young patients without other stroke risk factors, and may recur in up to 20% of cases within two years. Despite their clinical significance, there are no clear guidelines for managing CaWs. This review discusses the epidemiology, pathogenesis, pathophysiology, diagnosis, and treatment options for CaWs. CaWs are characterized by focal intimal hyperplasia, distinct from classic fibromuscular dysplasia and atherosclerosis. They are more common in younger individuals, African Americans, and females. CaWs are associated with altered blood flow and stasis, promoting thrombogenesis and increasing the risk of embolic strokes. The size and morphology of CaWs are linked to stroke risk, with larger and more acute-angled CaWs being more likely to cause strokes. Diagnosis of CaWs involves imaging modalities such as CTA, MR angiography, ultrasound, and catheter angiography. CTA is the most widely used, but CaWs are often missed in real-world practice. Multiplanar reconstructions are essential for accurate diagnosis. MR angiography and vessel wall imaging can also detect CaWs, while ultrasound is less reliable due to lower resolution. Intravascular ultrasound and optical coherence tomography are emerging tools for better characterization. Treatment options include carotid stenting and carotid endarterectomy. Stenting has shown high efficacy in preventing recurrent strokes, with no major complications in studies. Carotid endarterectomy is also effective, with no perioperative complications in case series. Both procedures are generally safe, with low complication rates compared to historical data for carotid interventions. While medical management with antiplatelet therapy is used, it may not be sufficient to prevent stroke recurrence. Carotid interventions are recommended for symptomatic CaWs, particularly in patients with a high risk of recurrence. Future studies are needed to compare the efficacy of stenting and endarterectomy and to optimize treatment strategies based on CaW size and morphology. The choice between stenting and endarterectomy depends on patient factors, proceduralist experience, and individual anatomical features.