Eur J Vasc Surg 6, 368-370 (1992)
The Carotid Stump Syndrome L. Cassidy, P. A. Grace and D. J. Bouchier-Hayes Department of Surgery, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Republic of Ireland Transient ischaemic attacks (TIAs) following internal carotid artery occlusion are not uncommon. Micro-embolisation from an ipsilateraI internal carotid artery stump has been implicated in the pathogenesis of such TIAs. We report six patients who had persistent TIAs in association wi& an occluded ipsilateraI internal carotid artery and a carotid stump. Four patients who underwent surgery and stump exclusion remain asymptomatic at 2 years while of two patients who were treated with antiplatelet therapy, one remains asymptomatic and one died from a cerebro-vascular accident. Key Words: Carotid artery; Transient ischaemic attack.
Introduction
sented with transient ocular or cerebral symptoms (Table 1). Four patients had transient hemiparesis, Several authors have reported persistence of cerebral two had dysphasia and two had amaurosis fugax. or retinal ischaemic symptoms after occlusion of an Two patients reported having more than 50 transient ipsilateral internal carotid artery. 1 3 The pathogenesis ischaemic attacks (TIAs) and all patients experienced of these symptoms has been attributed either to epi- symptoms up to the time of surgery. The ischaemic sodes of cerebral hypoperfusion or intermittent episodes were within the territory of an occluded micro-embolisation. The failure of the external ca- internal carotid artery in all six patients, and in a rotid/internal carotid bypass study to demonstrate an single patient (patient 4) fundoscopic examination by advantage for surgery in patients with an occluded an ophthalmologist showed an embolus of the retinal ipsilateral internal carotid artery has cast some doubt artery. Duplex scanning showed internal carotid on the hypoperfusion theory. 4 Possible sources of artery occlusion, and angiography demonstrated a micro-emboli are: (1) a patent proximal remnant of patent proximal remnant, i.e. a carotid stump, in all the occluded internal carotid artery, i.e. the carotid patients (Fig. 1). No patient had symptoms referable stump; 1 (2) the ipsilateral common or external carotid to the territory of the contralateral carotid artery but artery; 5 (3) the distal thrombus occluding the ipsilat- two patients had haemodynamically significant eral internal carotid artery; 6 and (4) the contralateral contralateral stenoses. The other four patients had carotid vessels. 7 A carotid stump may be present in minimal (
The Carotid Stump Syndrome L. Cassidy, P. A. Grace and D. J. Bouchier-Hayes Department of Surgery, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Republic of Ireland Transient ischaemic attacks (TIAs) following internal carotid artery occlusion are not uncommon. Micro-embolisation from an ipsilateraI internal carotid artery stump has been implicated in the pathogenesis of such TIAs. We report six patients who had persistent TIAs in association wi& an occluded ipsilateraI internal carotid artery and a carotid stump. Four patients who underwent surgery and stump exclusion remain asymptomatic at 2 years while of two patients who were treated with antiplatelet therapy, one remains asymptomatic and one died from a cerebro-vascular accident. Key Words: Carotid artery; Transient ischaemic attack.
Introduction
sented with transient ocular or cerebral symptoms (Table 1). Four patients had transient hemiparesis, Several authors have reported persistence of cerebral two had dysphasia and two had amaurosis fugax. or retinal ischaemic symptoms after occlusion of an Two patients reported having more than 50 transient ipsilateral internal carotid artery. 1 3 The pathogenesis ischaemic attacks (TIAs) and all patients experienced of these symptoms has been attributed either to epi- symptoms up to the time of surgery. The ischaemic sodes of cerebral hypoperfusion or intermittent episodes were within the territory of an occluded micro-embolisation. The failure of the external ca- internal carotid artery in all six patients, and in a rotid/internal carotid bypass study to demonstrate an single patient (patient 4) fundoscopic examination by advantage for surgery in patients with an occluded an ophthalmologist showed an embolus of the retinal ipsilateral internal carotid artery has cast some doubt artery. Duplex scanning showed internal carotid on the hypoperfusion theory. 4 Possible sources of artery occlusion, and angiography demonstrated a micro-emboli are: (1) a patent proximal remnant of patent proximal remnant, i.e. a carotid stump, in all the occluded internal carotid artery, i.e. the carotid patients (Fig. 1). No patient had symptoms referable stump; 1 (2) the ipsilateral common or external carotid to the territory of the contralateral carotid artery but artery; 5 (3) the distal thrombus occluding the ipsilat- two patients had haemodynamically significant eral internal carotid artery; 6 and (4) the contralateral contralateral stenoses. The other four patients had carotid vessels. 7 A carotid stump may be present in minimal (
