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.
Highlights
Complete occlusion of the internal carotid artery (ICA) with a patent proximal remnant of it, which can be demonstrated by carotid duplex scan, computed tomography angiography, or magnetic resonance angiography, is called carotids stump [1]
Surgical exclusion of the ICA stump combined with endarterectomy of the ipsilateral external carotid artery (ECA) and endovascular revascularization of the occluded ICA have been successful
Magnetic resonance imaging (MRI) of the brain showed acute on chronic left parietal lobe infarct in the left middle cerebral artery territory and complete occlusion of the left ICA with the carotid stump
Summary
Complete occlusion of the internal carotid artery (ICA) with a patent proximal remnant of it, which can be demonstrated by carotid duplex scan, computed tomography angiography, or magnetic resonance angiography, is called carotids stump [1]. Carotid stump syndrome (CSS) is defined as the persistence of cerebral or retinal ischemic symptoms after complete occlusion of the ipsilateral ICA [2]. The patient underwent physical and occupational therapy along with medical management, resulting in symptomatic improvement. He was discharged on a statin and single antiplatelet therapy. Magnetic resonance imaging (MRI) of the brain showed acute on chronic left parietal lobe infarct in the left middle cerebral artery territory and complete occlusion of the left ICA with the carotid stump. Since the patient was unwilling to undergo stump excision, he was medically managed with dual antiplatelet therapy with aspirin, dipyridamole, and high dose statin.
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