Carotid Stump as a Cause of Recurrent Embolism–Endovascular Treatment in a Case of Congenital Carotid Stump Syndrome

Shin, Jonghwa; Cha, Jihoon; Jeon, Pyoung; Bang, Oh Young

doi:10.5853/jos.2015.17.3.359

Cited by 4 publications

(9 citation statements)

References 3 publications

(3 reference statements)

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“…If the patient also presents severe atherosclerotic stenosis, treatment with carotid artery stenting or carotid endarterectomy is favorable; both treatments require an adequate distal protection device to reduce the risk of thromboembolic events [ 9 , 14 ]. Recurrent cerebrovascular events can originate from an arterial stump in a similar condition called carotid stump syndrome [ 15 ]; therefore, the risk of thromboembolic events during procedures cannot be overlooked in cases of an NBCA combined with an arterial stump, because the arterial stump may produce a turbulent flow in the NBCA. For patients in need of carotid intervention, preoperative evaluation of the branching pattern and stenosis region helps the surgeon in selecting a suitable distal protection device [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Nonbifurcating Carotid Artery: A Case Report with a Review of Embryogenesis

Lai

2018

Am J Case Rep

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Patient: Male, 66Final Diagnosis: Nonbifurcating carotid arterySymptoms: No symptomsMedication: —Clinical Procedure: —Specialty: NeurologyObjective:Congenital defects/diseasesBackground:Vascular anomalies of the carotid vessels can be attributed to false embryogenesis. A rare variant called a nonbifurcating carotid artery (NBCA) exists, where typical carotid bifurcation is not recognizable with its typical branches of the external carotid artery (ECA) and internal carotid artery (ICA). This paper describes a case of this anomaly and reviews the embryogenesis of the carotid arteries for explanation.Case Report:A 66-year-old man received a routine health examination at our hospital. Initial carotid ultrasound indicated an absence of bifurcation in the right cervical carotid artery, and magnetic resonance imaging of the brain indicated an absence of the proximal cervical segment of the right ICA, with a remnant arterial stump at the expected bifurcation level. No evidence of the carotid bulb was identified. The common carotid artery seemed to continue cranially in the trunk of the ECA, where it exhibited extracranial branches. After distributing these branches, the carotid artery coursed medially at the C2 level, where it ascended into the carotid canal to become the petrosal segment of the ICA. This carotid anomaly was labelled an NBCA. No aberrant intracranial arteries were derived from the NBCA in this case.Conclusions:In this case, the arterial stump was considered a remnant from agenesis of the right ICA. We assumed that the NBCA most likely developed because of false regression of the third embryogenic aortic arch with persistence of the second aortic arch.

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Section: Discussionmentioning

confidence: 99%

Nonbifurcating Carotid Artery: A Case Report with a Review of Embryogenesis

Lai

2018

Am J Case Rep

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“…Hrbáčd et al randomly divided patients with CSS into 2 groups: drug therapy group (n = 10) and surgical treatment group (n = 15), and the authors reported 1 patient in the drug therapy group with stroke recurrence, while 1 patient in the surgical treatment group died of myocardial infarction. [7] Kumar et al reported that among 25 patients with CSS who underwent surgical intervention, 23 patients were relieved of symptoms. However, 1 case of facial paralysis and dysarthria, 1 case of incisional hematoma, 2 cases of cranial nerve paralysis, 1 case of visual impairment, and 1 case of death were observed.…”

Section: Discussionmentioning

confidence: 99%

“…The interventions for CSS are mostly demonstrated via case reports. Two surgical approaches of intervention are isolating the occluded stump of ICA with a covered or bare stent to prevent embolization, [7–11] and filling the stump of the ICA with the coils supported by the stent to correct the abnormal blood flow in the residual lumen, and hence, prevent thrombosis. [12,13] Due to various limitations, no guidelines have been recommended for the direct interventional recanalization of carotid artery occlusion.…”

Section: Discussionmentioning

confidence: 99%

Interventional recanalization as a treatment of carotid stump syndrome caused by right internal carotid artery occlusion

Xu¹,

Wang

Luo³

2019

Medicine

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Rationale:Carotid stump syndrome is a cerebral infarction caused by an embolus formed subsequent to the vortex of blood flow from the occluded stump, which then moves through the collateral vessels into the brain. The covered stent and stent-assisted coil embolization stump are the effective interventions for the carotid artery stump.Patient concerns:A 71-year-old man twice experienced left limb weakness; diffusion weighted imaging confirmed the diagnosis of cerebral infarction. Cervical computed tomography angiography, intracranial magnetic resonance angiography, and digital subtraction angiography were conducted to evaluate collateral circulation, intraluminal composition, and shape of the carotid stump.Diagnoses:The patient was diagnosed with cerebral infarction and right carotid stump syndrome.Intervention:The patient underwent interventional recanalization of the occluded internal carotid artery, which relieved his symptoms and led to satisfactory therapeutic outcomes during the clinical follow-up.Outcomes:A 9-month clinical follow-up revealed no stroke recurrence.Lessons:Interventional recanalization for the carotid artery stump syndrome is feasible. Accurate preoperative evaluation including collateral circulation, intraluminal composition, and shape of the carotid stump can assure a successful vascularization and guided management.

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“…CSS was traditionally treated with the open surgical exclusion of the stump and endarterectomy of the ECA [7]. More recently, endovascular treatments involving common carotid artery (CCA)-to-ECA stenting have gained popularity [3,8,9]. Despite multiple case reports and small series of endovascular treatments for CSS, there has been no review of the existing literature to establish the efficacy and safety of endovascular intervention for the treatment of CSS.…”

Section: Introductionmentioning

confidence: 99%

“…In this study, we present a systematic review of endovascular treatments for CSS and provide a case illustration of carotid stump exclusion with stent-assisted coil embolization. To our knowledge, this is the second study to describe stent-assisted coil embolization for CSS [8] and the only study to review the literature in its entirety and compile the endovascular data among these patients.…”

Section: Introductionmentioning

confidence: 99%

Carotid Stump Syndrome With Stent-Assisted Coil Embolization

Baker¹,

Sherrod²,

Gamboa³

et al. 2022

Cureus

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Carotid stump syndrome (CSS) is a rare cause of recurrent ipsilateral cerebrovascular events that typically manifests as transient ischemic attacks or amaurosis fugax. The cause of these recurrent symptoms is thought to be microembolization from an occluded internal carotid artery that reaches intracranial circulation through anastomoses. We undertook a systematic literature review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the PubMed, Web of Science, and Embase databases of the endovascular treatment options for CSS. Nine papers met the inclusion criteria and provided patient data on 12 patients, and one case illustration is presented. Treatment was with common carotid artery-external carotid artery stent graft without concomitant coil embolization in nine patients and with coil embolization without stenting, the breakthrough of the stump with a wire and subsequent internal carotid artery stent placement, and stent-assisted coil embolization in one patient each. During a median follow-up of six months, all patients were on dual antiplatelet therapy except one on undefined "systemic anticoagulation." Twelve patients had no symptoms after treatment, one had transient expressive aphasia but no further symptoms after being placed on anticoagulation, and none had intraprocedural complications or had to undergo retreatment. Our review indicates that endovascular treatment of CSS is associated with low intraprocedural risk and is effective at treating recurrent symptoms.

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Carotid Stump as a Cause of Recurrent Embolism–Endovascular Treatment in a Case of Congenital Carotid Stump Syndrome

Cited by 4 publications

References 3 publications

Nonbifurcating Carotid Artery: A Case Report with a Review of Embryogenesis

Nonbifurcating Carotid Artery: A Case Report with a Review of Embryogenesis

Interventional recanalization as a treatment of carotid stump syndrome caused by right internal carotid artery occlusion

Carotid Stump Syndrome With Stent-Assisted Coil Embolization

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