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Rossi SS, Iaccarino G, Bonura A, Calandrelli R, Spinelli F, Montelione N, Paraskevas KI, Di Lazzaro V, Stilo F, Pilato F. Exploring vertebral artery stump syndrome: An overlooked cause of posterior ischemic strokes. A narrative review of current management options. J Stroke Cerebrovasc Dis 2024; 33:107819. [PMID: 38878845 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/31/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Stump syndrome is defined as a clinical syndrome resulting from a distal intracranial vessel embolic stroke due to an extracranial vessel occlusion. Similar to the anterior circulation, the recurrence of ischemic strokes in territories supplied by the posterior circulation in the presence of vertebral artery occlusion is termed Vertebral Artery Stump Syndrome (VASS). MATERIAL AND METHODS We conducted a literature review, identifying 72 patients with transient ischemic attacks (TIAs) or ischemic strokes attributed to VASS, according to Kawano criteria. We categorized all patients in two groups focusing on the therapeutic management those who underwent primary medical treatment and those who received endovascular or surgical treatment either in acute or chronic phase. RESULTS In the anticoagulant therapy group, only 1 patient had a stroke recurrence. Among the 4 on antiplatelets, all had recurrences, but 3 benefited from switching to anticoagulants or endovascular therapy. In the endovascular therapy group, worse outcomes were linked to acute large vessel occlusion. Endovascular treatment of the vertebral artery, in a chronic phase, was explored in literature for recurrent TIAs or minor strokes suggesting that this could be a viable therapeutic alternative when medical treatment failed in preventing recurrence of ischemic stroke. CONCLUSIONS Some studies suggest that anticoagulant medical therapy may be beneficial for VASS and endovascular therapy has also been reported for selected patients. However, data on treatment outcomes and prognosis are still underreported, making treatment decisions challenging. Randomized Controlled Trials are needed to establish the optimal treatment approach.
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Affiliation(s)
- Sergio Soeren Rossi
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Gianmarco Iaccarino
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Adriano Bonura
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Rosalinda Calandrelli
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesco Spinelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy; Vascular Surgery Division, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy
| | - Nunzio Montelione
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy; Vascular Surgery Division, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy
| | | | - Vincenzo Di Lazzaro
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Francesco Stilo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy; Vascular Surgery Division, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy
| | - Fabio Pilato
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy.
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Alenezi S, Saleem A, Alenezi A, Alhajri O, Khuraibet S, Ameer A. Sudden unilateral eye pain with vision loss related to carotid stump syndrome; A case report and literature review. Int J Surg Case Rep 2023; 106:108208. [PMID: 37068458 PMCID: PMC10130206 DOI: 10.1016/j.ijscr.2023.108208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Carotid stump syndrome (CSS) is a rare cause of recurrent ipsilateral cerebrovascular accidents (CVAs) resulting from completely occluded internal carotid artery (ICA). In this condition, hemodynamic and embolic risks are related to cerebral and retinal ischemic strokes. PRESENTATION OF CASE A 65-year-old gentleman with multiple comorbidities, presented to our hospital with a sudden painful unilateral vision loss of the right eye. Head CT was done upon arrival, showing no evidence of ischemic or hemorrhagic brain insult and multiple right frontoparietal old infarct lesions were detected. Central retinal artery occlusion diagnosis was confirmed by an ophthalmologist. CT angiogram of the brain and carotids was done and revealed an obliterated, thrombosed, and non-opacified right internal carotid artery from the carotid bifurcation up to intracranial petrous/foramen lacerum. After taking the patient's surgical consent, right carotid stump endarterectomy and ligation of the stump under general anesthesia was done and the postoperative period was uneventful. CLINICAL DISCUSSION CSS is an uncommon underlying etiology, causing recurrent stroke events. The clinical features of this syndrome include cerebral and ophthalmology symptoms. Diagnosis of CSS relies on imaging modalities. Internal carotid artery stump surgical excision through the ipsilateral ECA endarterectomy is the gold standard for CSS treatment. CONCLUSION Despite being a rare entity, CSS is a treatable cause of retinal embolic events TIAs. Therefore, it is important to raise awareness of such condition. The presented case demonstrates the diagnosis, management and prognosis of CSS.
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Affiliation(s)
- Saqer Alenezi
- Vascular surgery department, Jaber Al Ahmad Hospital, Kuwait.
| | - Athary Saleem
- Vascular surgery department, Jaber Al Ahmad Hospital, Kuwait
| | - Ali Alenezi
- Vascular surgery department, Jaber Al Ahmad Hospital, Kuwait
| | - Omar Alhajri
- Vascular surgery department, Jaber Al Ahmad Hospital, Kuwait
| | - Salma Khuraibet
- Vascular surgery department, Jaber Al Ahmad Hospital, Kuwait
| | - Ahmed Ameer
- Vascular surgery department, Jaber Al Ahmad Hospital, Kuwait
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Baker C, Sherrod B, Gamboa NT, Taussky P, Grandhi R. Carotid Stump Syndrome With Stent-Assisted Coil Embolization. Cureus 2022; 14:e22746. [PMID: 35371850 PMCID: PMC8970411 DOI: 10.7759/cureus.22746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/05/2022] Open
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Garg PK, Tiwari S, Ghosh TS, Patel S, Sharma A, Khera PS. Cascade of Complications Following Carotid Body Tumor Excision. Neurointervention 2021; 16:298-302. [PMID: 34583451 PMCID: PMC8561026 DOI: 10.5469/neuroint.2021.00248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
Carotid body tumor excision can lead to various complications including vascular injury and pseudoaneurysm formation. Here we describe a case of carotid body tumor excision followed by series of complications including pseudoaneurysm formation, failure of primary surgical repair, carotid stump syndrome following parent artery occlusion, and persistent hypotension.
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Affiliation(s)
- Pawan K Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Tushar S Ghosh
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Surendra Patel
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Ankur Sharma
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | - Pushpinder S Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
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Hashimoto G, Wada S, Morita T, Tomohara S, Hara K, Kumabe M, Matsushima T, Kadowaki M, Hamaguchi M, Kuwashiro T, Yasaka M, Okada Y. Ischemic Stroke Caused by Carotid Stump at the Common Carotid Artery. Intern Med 2020; 59:3071-3074. [PMID: 32727984 PMCID: PMC7759691 DOI: 10.2169/internalmedicine.5021-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
An 84-year-old man developed motor aphasia and right hemiparesis on postoperative day 1 after orchiectomy for suspected malignant lymphoma. He had a history of thoracic endovascular aortic repair for aortic aneurysm using a bypass graft from the right subclavian artery to the left common carotid artery (CCA); however, the graft had become occluded six months later. Brain magnetic resonance imaging revealed acute cerebral infarctions in the left frontal lobe. Carotid ultrasonography revealed a stump at the left CCA, just below the bifurcation, formed by the occluded graft with an oscillating thrombus. This case was rare in that a CCA stump was identified as the embolic source of ischemic stroke.
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Affiliation(s)
- Go Hashimoto
- Division of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospitalization Organization, Kyushu Medical Center, Japan
| | - Shinichi Wada
- Division of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospitalization Organization, Kyushu Medical Center, Japan
| | - Takao Morita
- Division of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospitalization Organization, Kyushu Medical Center, Japan
| | - Saori Tomohara
- Division of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospitalization Organization, Kyushu Medical Center, Japan
| | - Kenta Hara
- Division of Neuroendovascular Therapy, Clinical Research Institute, National Hospitalization Organization, Kyushu Medical Center, Japan
| | - Mitsuru Kumabe
- Department of Clinical Education and Training Center, National Hospitalization Organization, Kyushu Medical Center, Japan
| | - Takumi Matsushima
- Department of Hematology, Clinical Research Institute, National Hospitalization Organization, Kyushu Medical Center, Japan
| | - Masanori Kadowaki
- Department of Hematology, Clinical Research Institute, National Hospitalization Organization, Kyushu Medical Center, Japan
| | - Masumitsu Hamaguchi
- Department of Urology, Clinical Research Institute, National Hospitalization Organization, Kyushu Medical Center, Japan
| | - Takahiro Kuwashiro
- Division of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospitalization Organization, Kyushu Medical Center, Japan
| | - Masahiro Yasaka
- Division of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospitalization Organization, Kyushu Medical Center, Japan
| | - Yasushi Okada
- Division of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospitalization Organization, Kyushu Medical Center, Japan
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Dulai M, Elsherif M, Tawfick W, Kavanagh EP, Hynes N, Sultan S. Outcome following open and endovascular intervention for carotid stump syndrome. SAGE Open Med Case Rep 2018; 6:2050313X18779744. [PMID: 29977555 PMCID: PMC6024327 DOI: 10.1177/2050313x18779744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/27/2018] [Indexed: 11/22/2022] Open
Abstract
Carotid stump syndrome is defined as the persistence of retinal or cerebral ischaemic events with complete occlusion of the ipsilateral internal carotid artery. The aim of this retrospective cases series was to assess the outcomes for patients with carotid stump syndrome managed with surgical intervention. A series of 11 cases of carotid stump syndrome in nine patients presented to our tertiary vascular centre from October 2004 to February 2016. Indications for intervention were amaurosis fugax, transient ischaemic attacks and stroke. In total, 11 procedures were performed on nine patients including carotid angioplasty and stenting or carotid endarterectomy with patching. The mean follow-up period was 56.6 months. One patient suffered a myocardial infarction 30 days, post-operatively, and one patient was lost to follow-up. In the remaining seven patients, there was a complete resolution of symptoms. There were no incidents of death, stroke, cranial nerve injury, wound haematoma or procedural bleeding. Surgical exclusion of carotid stumps combined with dual antiplatelet agents was found to be a safe and effective treatment method for carotid stump syndrome.
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Affiliation(s)
- Makinderjit Dulai
- Western Vascular Institute, Department of Vascular & Endovascular Surgery, University Hospital Galway, National University of Ireland Galway, Galway, Ireland
| | - Mohamed Elsherif
- Western Vascular Institute, Department of Vascular & Endovascular Surgery, University Hospital Galway, National University of Ireland Galway, Galway, Ireland
| | - Wael Tawfick
- Western Vascular Institute, Department of Vascular & Endovascular Surgery, University Hospital Galway, National University of Ireland Galway, Galway, Ireland
| | - Edel P Kavanagh
- Western Vascular Institute, Department of Vascular & Endovascular Surgery, University Hospital Galway, National University of Ireland Galway, Galway, Ireland.,Galway Clinic, Royal College of Surgeons in Ireland, Galway, Ireland
| | - Niamh Hynes
- Western Vascular Institute, Department of Vascular & Endovascular Surgery, University Hospital Galway, National University of Ireland Galway, Galway, Ireland.,Galway Clinic, Royal College of Surgeons in Ireland, Galway, Ireland
| | - Sherif Sultan
- Western Vascular Institute, Department of Vascular & Endovascular Surgery, University Hospital Galway, National University of Ireland Galway, Galway, Ireland.,Galway Clinic, Royal College of Surgeons in Ireland, Galway, Ireland
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