Carotid Stump Syndrome With Stent-Assisted Coil Embolization

Abstract

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.

Sudden unilateral eye pain with vision loss related to carotid stump syndrome; A case report and literature review

“…This type of stroke is mainly characterized by non-identifiable causes, accounting for up to 25 % of patients with stroke [9] . CSS is an uncommon disorder that was first described in 1978 [1] , [7] . A study demonstrated that an obstructed ICA increases the risk of an ipsilateral cerebrovascular accident by 3 to 5 % per year [5] , [10] .…”

“…Pathophysiologically, CSS is thought to be caused by ipsilateral microembolization to the external carotid artery (ECA) and ophthalmic artery. Through retrograde collaterals, microemboli migrate to the intracranial pathways through the ECA and ophthalmic arteries [2] , [7] , [11] . The thromboemboli in the completely obstructed ICA can be the cause of cerebral embolization [2] .…”

“…In the case of hypoperfusion, generalized symptoms should be suspected by the physician. Furthermore, turbulence within the carotid stump can enhance microembolization [4] , [7] .…”

“…Although of its rarity, this syndrome is more likely to be missed leading to improper assessment and treatment that lead to recurrent symptoms and irreversible neurological deficit [7] .…”