Carotid Stump Syndrome: Repetitive Ischemic Symptoms After Internal Carotid Artery Occlusion Treated with ECA-CCA Stenting

José E. Cohen*, Andrei Filioglo, Hans Henkes, Gustavo Rajz, Zion Zibli

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

Carotid stump syndrome (CSS) is considered a rare cause of recurrent ipsilateral cerebrovascular events that are thought to be caused by microembolization from an occluded internal carotid artery (ICA). There are multiple theories regarding the etiology of these events, but many believe the syndrome results from microembolization from the ICA stump into the external carotid artery (ECA) and then into the intracranial circulation via ECA-to-ICA anastomoses. If CSS is not diagnosed and appropriately treated, it can lead to recurrent symptoms and neurologic impairment. Surgical and endovascular options have been described. While these options cannot be compared, they both seem effective in preventing further embolic events. Here we present the case of a 72-year-old man with a history of a minor left hemispheric ischemic stroke after left ICA occlusion in 2017, who was transferred to our hospital with acute-onset, right-side weakness and worsening speech from baseline (National Institutes of Health Stroke Scale [NIHSS] score of 6). CT angiography (CTA) confirmed occlusion of the left extracranial ICA. He was started on dual antiplatelet therapy with aspirin and clopidogrel and discharged home with an NIHSS of 2. He returned to our hospital 2 weeks later with clinical evidence of a new left hemispheric embolic stroke (NIHSS score of 5). The most probable mechanism of stroke induction was considered an arterial embolism originating either from the ulcerated atherosclerotic lesion at the ECA ostium or an irregular plaque at the ICA ostium that had propagated intracranially through ECA-to- ICA anastomotic channels. We proceeded to implant a stent from the left ECA to the common carotid artery (CCA). In this way, we dilated the origin of the ECA and jailed the ICA origin. The patient was discharged home after 3 days and was asymptomatic at 3- and 12-month follow-up. Endovascular management of CSS is the main topic of this chapter.

Original languageEnglish
Title of host publicationThe Ischemic Stroke Casebook
Subtitle of host publicationClinical and Endovascular Approaches to Revascularization
PublisherSpringer Nature
Pages69-77
Number of pages9
ISBN (Electronic)9783031472015
ISBN (Print)9783031472008
DOIs
StatePublished - 1 Jan 2024
Externally publishedYes

Keywords

  • Carotid occlusion
  • Carotid stent
  • Carotid stump syndrome
  • Embolic stroke
  • Ischemic stroke

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