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Here, we describe a case of a 67-year-old man who was transferred to our hospital with complaints of sudden upper right limb weakness and ataxia. Scattered acute cerebral infarction was found in the watershed zone between the left anterior cerebral artery and the middle cerebral artery territories. A shelf-like structure at the origin of the left carotid artery and a vulnerable plaque distal to the lesion was found. Symptomatic atherosclerotic plaque with concomitant carotid web was diagnosed. Carotid endarterectomy resulted in good revascularization. Hemodynamic changes associated with vascular stenosis are involved in atherosclerosis. The current case is valuable and shows that carotid web can cause not only embolic infarction but also cerebral thrombosis due to atheroma formation in the carotid artery. [ABSTRACT FROM AUTHOR]