Carotid Stump Syndrome: Case Report and Endovascular Treatment.

Lara Toufic Dakhoul,Rabih Tawk

doi:10.1177/2324709614548796

Abstract

Objectives. To highlight the case of a patient with multiple transient ischemic attacks and visual disturbances diagnosed with carotid stump syndrome and managed with endovascular approach. Case Presentation. We present the case of a carotid stump syndrome in an elderly patient found to have moderate left internal carotid artery stenosis in response to an advertisement for carotid screening. After a medical therapeutic approach and a close follow-up, transient ischemic attacks recurred. Computed tomographic angiography showed an occlusion of the left internal carotid artery and the presence of moderate stenosis in the right internal carotid artery, which was treated by endovascular stenting and balloon insertion. One month later, the patient presented with visual disturbances due to the left carotid stump and severe stenosis of the left external carotid artery that was reapproached by endovascular stenting. Conclusion. Considerations should be given to the carotid stump syndrome as a source of emboli for ischemic strokes, and vascular assessment could be used to detect and treat this syndrome.

Highlights

Carotid stump syndrome (CSS) is one of the recognized causes of recurrent ipsilateral cerebrovascular events caused by occlusion of the internal carotid artery (ICA).[1]
The article presents a case of a female patient initially suffering from left ICA occlusion that is diagnosed with CSS and managed with endovascular wall stenting
CSS should be considered as a likely clinical entity in patients with an occluded ICA and persisting cerebral and retinal microembolic symptoms.[6]

Summary

Introduction

Carotid stump syndrome (CSS) is one of the recognized causes of recurrent ipsilateral cerebrovascular events caused by occlusion of the internal carotid artery (ICA).[1] As this infrequently occurs, it is responsible for ischemic strokes of the carotid territory. Microembolization from an ipsilateral ICA stump has been observed in the pathogenesis of such transient ischemic attacks (TIAs).[2] The main pathophysiology of the syndrome is caused by the migration of microemboli to the ipsilateral external carotid artery (ECA) and the ophthalmic artery. These emboli move from the external carotid and ophthalmic arteries to the intracranial circulation via retrograde collateral pathways. The article presents a case of a female patient initially suffering from left ICA occlusion that is diagnosed with CSS and managed with endovascular wall stenting

Objectives

Discussion

Conclusion