Carotid Stump Syndrome: An Uncommon Cause of Recurrent Ipsilateral Strokes

Abstract

Carotid stump syndrome is a rare cause of recurrent cerebrovascular accidents. Carotid stump is the patent proximal remnant below the completely occluded internal carotid artery (ICA). Cerebral and retinal ischemic symptoms seen after complete occlusion of ipsilateral ICA is known as carotid stump syndrome. Known for causing recurrent ipsilateral cerebrovascular accidents, it is a potentially treatable entity. The therapeutic goal is medical management with a statin, dual anti-platelet therapy along with surgical intervention either with an endovascular repair or carotid endarterectomy. Herein, we present a case of carotid stump syndrome managed medically.

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

“…The hemodynamic instability in the occluded ICA that causes cerebral hypoperfusion and recurrent microembolization from the thrombotic carotid stump to the brain, respectively, have been used to describe hemodynamic and embolic variables contributing to the recurrence of cerebral or retinal manifestations [3] , [13] .…”

“…Diagnosis of CSS relies on specific imaging modalities such as CT angiography, MR angiography, and carotid duplex scan [3] , [6] , [14] . D.S.Quill et al documented the role of the color doppler flow imaging in patient assessment, diagnosis, and the ability to develop late symptoms [14] .…”

“…The definitive treatment of CSS is surgery either by open techniques or endovascular approaches [1] , [3] , [15] . Internal carotid artery stump surgical excision through the ipsilateral ECA endarterectomy is the gold standard for CSS treatment.…”

“…Besides optimal medical therapy, several studies recommended the surgical option for symptomatic patients [11] , [15] , [16] . Additionally, endovascular treatment options are effective alternatives for the recanalization and prevention of cerebral vascular accidents [3] , [10] .…”

“…CSS is detected as a proximal patent remnant located below a totally occluded internal carotid artery. In such conditions, hemodynamic and embolic risks are related to cerebral and retinal ischemic strokes, causing recurrent transient ischemic attacks (TIAs) and cerebrovascular events [2] , [3] , [4] . With an ipsilateral stroke rate of 3–5 % per year, the overall risk of mortality or stroke from internal carotid artery blockage is 30 % [5] , [6] .…”