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Rossi SS, Iaccarino G, Bonura A, Calandrelli R, Spinelli F, Montelione N, Paraskevas KI, Di Lazzaro V, Stilo F, Pilato F. Exploring vertebral artery stump syndrome: An overlooked cause of posterior ischemic strokes. A narrative review of current management options. J Stroke Cerebrovasc Dis 2024; 33:107819. [PMID: 38878845 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/31/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Stump syndrome is defined as a clinical syndrome resulting from a distal intracranial vessel embolic stroke due to an extracranial vessel occlusion. Similar to the anterior circulation, the recurrence of ischemic strokes in territories supplied by the posterior circulation in the presence of vertebral artery occlusion is termed Vertebral Artery Stump Syndrome (VASS). MATERIAL AND METHODS We conducted a literature review, identifying 72 patients with transient ischemic attacks (TIAs) or ischemic strokes attributed to VASS, according to Kawano criteria. We categorized all patients in two groups focusing on the therapeutic management those who underwent primary medical treatment and those who received endovascular or surgical treatment either in acute or chronic phase. RESULTS In the anticoagulant therapy group, only 1 patient had a stroke recurrence. Among the 4 on antiplatelets, all had recurrences, but 3 benefited from switching to anticoagulants or endovascular therapy. In the endovascular therapy group, worse outcomes were linked to acute large vessel occlusion. Endovascular treatment of the vertebral artery, in a chronic phase, was explored in literature for recurrent TIAs or minor strokes suggesting that this could be a viable therapeutic alternative when medical treatment failed in preventing recurrence of ischemic stroke. CONCLUSIONS Some studies suggest that anticoagulant medical therapy may be beneficial for VASS and endovascular therapy has also been reported for selected patients. However, data on treatment outcomes and prognosis are still underreported, making treatment decisions challenging. Randomized Controlled Trials are needed to establish the optimal treatment approach.
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Affiliation(s)
- Sergio Soeren Rossi
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Gianmarco Iaccarino
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Adriano Bonura
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Rosalinda Calandrelli
- Radiology and Neuroradiology Unit, Department of Imaging, Radiation Therapy and Hematology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesco Spinelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy; Vascular Surgery Division, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy
| | - Nunzio Montelione
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy; Vascular Surgery Division, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy
| | | | - Vincenzo Di Lazzaro
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy
| | - Francesco Stilo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy; Vascular Surgery Division, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy
| | - Fabio Pilato
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Rome, Italy.
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Zhang W, Li C, Shi M, Zhou J, Yue F, Song K, Wang S. Comprehensive classifications for the endovascular recanalization of vertebral artery stump syndrome. J Interv Med 2023; 6:81-89. [PMID: 37409065 PMCID: PMC10318328 DOI: 10.1016/j.jimed.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 07/07/2023] Open
Abstract
Background and purpose: To share our single-center vertebral artery stump syndrome (VASS) treatment experience and assess the role of comprehensive classification based on anatomic development, proximal conditions, and distal conditions (PAD). Materials and methods Data were retrospectively collected from patients who underwent endovascular thrombectomy (EVT) at the Stroke Center of the First Hospital of Jilin University between January 2016 and December 2021. Among patients with acute ischemic stroke in the posterior circulation, those with acute occlusion of the intracranial arteries and occlusion at the origin of the vertebral artery confirmed by digital subtraction angiography were selected. The clinical data were summarized and analyzed. Results Fifteen patients with VASS were enrolled in the study. The overall success rate of surgical recanalization was 80%. The successful proximal recanalization rate was 70.6%, and the recanalization rates for P1, P2, P3, and P4 were 100%, 71.4%, 50%, and 66.67%, respectively. The mean operation times for the A1 and A2 types were 124 and 120 min, respectively. The successful distal recanalization rate was 91.7%, and the recanalization rates for types D1, D2, D3, and D4 were 100%, 83.3%, 100%, and 100%, respectively. Five patients experienced perioperative complications (incidence rate: 33.3%). Distal embolism occurred in three patients (incidence rate: 20%). No dissection or subarachnoid hemorrhage occurred in any patient. Conclusion EVT is a technically feasible treatment for VASS, and comprehensive PAD classification can, to a certain extent, help initially estimate the difficulty of surgery and provide guidance for interventional procedures.
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Katayama M, Endo H, Matsuda M, Kamiyama K, Osato T, Nakamura H. Vertebral artery stump syndrome: A 7-year follow-up case report. Radiol Case Rep 2022; 17:2923-2926. [PMID: 35755109 PMCID: PMC9218283 DOI: 10.1016/j.radcr.2022.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022] Open
Abstract
Vertebral artery stump syndrome is rare, but one of the most important causes of posterior circulation stroke. To our knowledge, no optimal treatment for vertebral artery stump syndrome has been established, and there are no reports of long-term follow-up. We describe a 69-year-old man with vertebral artery stump syndrome who attended our hospital because of vertigo. Magnetic resonance imaging detected right cerebellar infarcts. Digital subtraction angiography revealed severe stenosis (functional obstruction) at the origin of the right vertebral artery, with distal antegrade collateral flow from the deep cervical artery. We started him on argatroban and cilostazol, but symptoms recurred after 1 month. We changed from cilostazol to aspirin and clopidgrel, then terminated aspirin 1 month after recurrence. He continued on clopidgrel, and follow-up after 7 years showed no recurrence, including asymptomatic lesions.
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Okamoto A, Nakagawa I, Kotsugi M, Yokoyama S, Yamada S, Park YS, Nakase H. Endovascular vertebral artery orifice angioplasty for the prevention of acute ischemic stroke following vertebral artery stump syndrome. Surg Neurol Int 2022; 13:382. [PMID: 36128121 PMCID: PMC9479644 DOI: 10.25259/sni_515_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Vertebral artery stump syndrome (VASS) involves repeated acute ischemic stroke (AIS) in the posterior circulation following vertebral artery (VA) orifice occlusion. The presence of VA orifice occlusion makes endovascular thrombectomy (EVT) difficult to achieve and leads to posterior circulation stroke with unfavorable functional outcomes. Here, we report a case of endovascular VA orifice angioplasty for the right VA pseudo-occlusion to prevent AIS following VASS pathology. Case Description: In a 76-year-old man presenting with dizziness, angiography revealed right pseudo-occluded VA at the origin concomitant with the left VA occlusion. The posterior circulation depended on the right VA through collateral flow to the distal portion. Prophylactic endovascular VA angioplasty for the right pseudo-occluded VA at the orifice was achieved to prevent AIS with tandem lesions. In the present case, endovascular VA angioplasty can prevent acute embolic stroke in the posterior circulation following EVT-resistant VASS pathology. Conclusion: Clinicians should be aware that EVT is not easy in AIS following VASS due to access difficulties and the treatment strategy should be carefully considered.
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Ji R, Li B, Xu Z. Retrograde recanalisation for vertebral artery stump syndrome: a case report. Stroke Vasc Neurol 2022; 7:462-464. [PMID: 35354663 PMCID: PMC9614125 DOI: 10.1136/svn-2021-001407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/02/2022] [Indexed: 11/28/2022] Open
Abstract
Vertebral artery stump syndrome (VASS) is a rare disease associated with a posterior circulation stroke after vertebral artery origin occlusion. We have herein presented a case of VASS that was effectively treated with endovascular intervention using retrograde recanalisation and the mechanism of VASS in our patient was thought to be a thrombus formed by stagnating flow.
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Affiliation(s)
- Renjie Ji
- Neurology, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Bing Li
- Neurology, Shulan hospital, Hangzhou, Zhejiang, China
| | - Ziqi Xu
- Neurology, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, Zhejiang, China
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Zhang W, Wang S, Li C, Wang Z, Yue F, Zhou J, Song K, Wang C, Wang Y, Shi M. A Case Series and Literature Review of Vertebral Artery Stump Syndrome. Front Neurol 2022; 12:770845. [PMID: 35153978 PMCID: PMC8831726 DOI: 10.3389/fneur.2021.770845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/23/2021] [Indexed: 01/01/2023] Open
Abstract
PurposeStump syndrome refers to cerebral ischaemic symptoms caused by an embolus from a previously occluded ipsilateral artery that occludes a down-stream artery. It can be divided into two types: carotid stump syndrome and vertebral artery stump syndrome (VASS). At present, there is limited clinical experience with VASS. We aimed to propose a more precise diagnostic standard for VASS, and to share our experience with handling this condition.Materials and MethodsWe retrospectively collected data of patients who were treated with endovascular thrombectomy in the stroke centre of the First Hospital of Jilin University from January 2016 to March 2020. After screening patients with posterior-circulation acute ischaemic stroke, we selected patients who had an acute occlusion of an intracranial artery in the context of a previously occluded ipsilateral vertebral artery origin, as confirmed by digital subtraction angiography.ResultsEleven patients met our inclusion criteria. Nine patients achieved recanalization of both extracranial and intracranial occluded arteries, one patient had modified thrombolysis in cerebral infarction grade 3, and eight patients had grade 2b. Residual stenosis of recanalized intracranial arteries was less than 30% in all cases, while three patients had embolism of distal arteries. No dissection or subarachnoid haemorrhage occurred. Two patients didn't reach vascular recanalization. Among the nine patients with recanalized artery, four had a 90-day modified Rankin Scale score ≤ 3 (favourable outcome), and four patients died; As for the two non-recanalized patients, one had a mRS score of 5 and one died.ConclusionVASS is a clinical syndrome caused by embolic occlusion of a distal intracranial artery occluded ipsilateral extracranial vertebral artery. Antegrade blood flow from the collateral vessels, distal embolic occlusion and mild or no residual stenosis of the occluded intracranial artery after recanalization are notable features of this clinical event. Endovascular thrombectomy may be effective for treating VASS.
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Affiliation(s)
- Wenbin Zhang
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Shouchun Wang
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Chao Li
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Zhongxiu Wang
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Feixue Yue
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Jie Zhou
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Kangjia Song
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Chao Wang
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Yujiao Wang
- Nursing Department, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
| | - Mingchao Shi
- Department of Neurology, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China
- *Correspondence: Mingchao Shi
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Yamano A, Nakai Y, Akutagawa K, Igarashi H, Tsukada K, Terakado T, Uemura K, Ishikawa E. Fatal recurrent ischemic stroke caused by vertebral artery stump syndrome. Surg Neurol Int 2021; 12:445. [PMID: 34621560 PMCID: PMC8492412 DOI: 10.25259/sni_384_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Vertebral artery stump syndrome (VASS) develops into recurrent posterior circulation ischemic stroke after ipsilateral vertebral artery (VA) occlusion at its origin. Case Description: The patient was a 46-year-old man with the right posterior cerebral artery occlusion. We used a recombinant tissue plasminogen activator (rt-PA) and then performed mechanical thrombectomy using a stent retriever. Angiography revealed left VA occlusion and stagnant flow to the left VA from the right deep cervical artery; therefore, we diagnosed VASS. Within 24 h of the rt-PA injection, the symptoms had dramatically improved, and so we avoided additional antithrombotic agents. Only 13 h later, the patient developed a basilar artery occlusion and died in spite of a repeated mechanical thrombectomy. Conclusion: Vigilance against early (and sometimes fatal) recurrent stroke induced by VASS is required.
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Affiliation(s)
- Akinari Yamano
- Department of Neurosurgery, University of Tsukuba, Japan
| | - Yasunobu Nakai
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | | | - Haruki Igarashi
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | | | | | - Kazuya Uemura
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
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Oda K, Noda M, Ishibashi T, Kogiku M, Abe K, Kishi H, Morita A. Percutaneous transluminal angioplasty for suspected vertebral artery stump syndrome. Neuroradiol J 2021; 33:520-524. [PMID: 33283670 DOI: 10.1177/1971400920939077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Vertebral artery stump syndrome is a rare disease associated with a posterior circulation stroke after vertebral artery origin occlusion. However, few reports have addressed its management. We herein present a case involving a patient with vertebral artery stump syndrome who underwent successful intravascular intervention. We also present a literature review of previous cases of this rare disease. The present case involved a 91-year-old man with acute onset of vertigo and disturbance of consciousness. Diffusion-weighted imaging showed an acute ischaemic stroke in the bilateral cerebellar hemispheres. Magnetic resonance angiography revealed left vertebral artery origin occlusion. Angiography detected a nearly occluded left vertebral artery site, with distal antegrade collateral flow via the deep cervical artery at the C6 level. We observed intravascular stasis at the proximal end of the left vertebral artery via the collateral flow. We performed percutaneous transluminal angioplasty towards the occluded left vertebral artery site. The flow from the left vertebral artery was significantly improved. This is the first report of percutaneous transluminal angioplasty performed for vertebral artery stump syndrome. Although vertebral artery stump syndrome has a high risk of recurrence and a poor prognosis, endovascular intervention showed a better outcome than pharmacotherapy in our patient. However, such cases are rare and further investigations are needed.
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Affiliation(s)
- Kazunori Oda
- Department of Neurosurgery, Yokohama Shin Midori General Hospital, Kanagawa, Japan.,Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Masayuki Noda
- Department of Neurosurgery, Yokohama Shin Midori General Hospital, Kanagawa, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Minoru Kogiku
- Department of Neurosurgery, Yokohama Shin Midori General Hospital, Kanagawa, Japan
| | - Katsutoshi Abe
- Department of Neurosurgery, Yokohama Shin Midori General Hospital, Kanagawa, Japan
| | - Hirohisa Kishi
- Department of Neurosurgery, Yokohama Shin Midori General Hospital, Kanagawa, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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Abstract
Carotid stump syndrome is a well-documented embolic source for ischemic stroke. However, few cases have been reported of a similar condition - termed vertebral artery stump syndrome - which affects the posterior circulation after vertebral artery origin occlusion. We herein report a case of infarction of the right superior cerebellar artery and left posterior inferior cerebellar artery territories due to vertebral artery stump syndrome. In this interesting case, a turbulent flow at the distal side of the vertebral artery occlusion was captured on ultrasonography, and was identified as the probable mechanism of vertebral artery stump syndrome.
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Affiliation(s)
- Masato Suzuki
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Japan
| | - Tomohisa Dembo
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Japan
| | - Wataru Hara
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Japan
| | - Takashi Tajima
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Japan
| | - Minako Yamashita
- Department of Laboratory Medicine, Saitama Medical Center, Saitama Medical University, Japan
| | - Satoru Oji
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Japan
| | - Kyoichi Nomura
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Japan
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Tempaku A. Cerebral angiography directly visualizes to-and-fro stream of vertebral artery stump syndrome. J Gen Fam Med 2017; 18:462-463. [PMID: 29264092 PMCID: PMC5729357 DOI: 10.1002/jgf2.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 03/21/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Akira Tempaku
- Department of Neurosurgery Hokuto Hospital Obihiro Hokkaido Japan
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Yagi K, Nakagawa H, Mure H, Okita S, Nagahiro S. Cryptic Recanalization of Chronic Vertebral Artery Occlusion by Head Rotation. J Stroke Cerebrovasc Dis 2017; 26:e60-e61. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.12.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/26/2016] [Accepted: 12/31/2016] [Indexed: 10/20/2022] Open
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Zhang XU, Shao S, Zheng X, Gao X, Zhang Y. Carotid stump syndrome: A case report. Exp Ther Med 2015; 10:1161-1164. [PMID: 26622457 DOI: 10.3892/etm.2015.2648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 06/22/2015] [Indexed: 11/05/2022] Open
Abstract
Carotid stump syndrome (CSS) is known to be one of the causes of recurrent ipsilateral ischemic stroke following the occlusion of the internal carotid artery (ICA). The present study describes a case of left CSS in a 50-year-old patient presenting with a central retinal artery embolism following internal carotid and middle cerebral artery occlusion. The central retinal artery embolism was believed to be a consequence of microemboli, which originated from the stump of the occluded ICA, passing into the ophthalmic artery due to external carotid-internal carotid anastomotic channels, although the other possible pathophysiological causes of this condition are discussed. Digital subtraction angiography of the patient showed trickle flow in the occluded ICA during the venous phase, by which the stump emboli may have been transported to the ophthalmic artery. The patient was successfully treated with anticoagulation therapy without surgical or endovascular treatment.
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Affiliation(s)
- X U Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Shixiu Shao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Xueping Zheng
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Xiang Gao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Yong Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
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Chembala J, Jadun C, Natarajan I, Roffe C. Coiling occlusion of the vertebral artery for a patient with recurrent posterior circulation TIAs. Neuroradiol J 2013; 26:80-3. [PMID: 23859172 DOI: 10.1177/197140091302600113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 12/13/2012] [Indexed: 11/16/2022] Open
Abstract
Recurrent posterior circulation infarcts frequently involve multiple vascular territories, suggesting an embolic source. We describe a patient with left vertebral artery occlusion who had recurrent transient ischaemic attacks due to cerebral embolization originating from the occluded vertebral artery in spite of optimal anticoagulant and antithrombotic treatment. This was successfully managed by coiling occlusion of the vertebral artery with no recurrence of symptoms over one year of follow-up. To our knowledge, this is the first report of coiling occlusion in the treatment of recurrent vertebral artery embolization.
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Affiliation(s)
- J Chembala
- Department of Stroke Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, Stafford, UK.
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Kawano H, Inatomi Y, Hirano T, Yonehara T. Vertebral artery stump syndrome in acute ischemic stroke. J Neurol Sci 2013; 324:74-9. [DOI: 10.1016/j.jns.2012.10.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 09/24/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
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