Navigating Diagnostic Uncertainty: A Case Report on Anesthetic Management of Mechanical Thrombectomy in a Patient With Occult Fibromuscular Dysplasia.

Fibromuscular dysplasia (FMD) is a rare, nonatherosclerotic vascular disease that predisposes patients to arterial stenosis, dissection, and stroke, often with delayed diagnosis due to nonspecific symptoms. We present a 30-year-old female with a history of migraines and recent whiplash injury who developed acute ischemic stroke from right internal carotid artery occlusion. Following neurological deterioration, she underwent emergent mechanical thrombectomy under general anesthesia. Airway management incorporated manual in-line stabilization to minimize cervical vessel stress, and hemodynamics were tightly controlled to balance cerebral perfusion and hemorrhagic risk. Postoperative imaging revealed arterial irregularities and a dissecting pseudoaneurysm consistent with previously undiagnosed FMD. The patient recovered with supportive care and was discharged on dual antiplatelet therapy. This case highlights the anesthetic challenges of managing acute stroke in the setting of occult vascular pathology and underscores the importance of maintaining suspicion for FMD in young patients with cerebrovascular events.