Baker Cordell, Sherrod Brandon, Gamboa Nicholas T, Taussky Philipp, Grandhi Ramesh
Neurosurgery, University of Utah, Salt Lake City, USA.
Cureus. 2022 Mar 1;14(3):e22746. doi: 10.7759/cureus.22746. eCollection 2022 Mar.
Carotid stump syndrome (CSS) is a rare cause of recurrent ipsilateral cerebrovascular events that typically manifests as transient ischemic attacks or amaurosis fugax. The cause of these recurrent symptoms is thought to be microembolization from an occluded internal carotid artery that reaches intracranial circulation through anastomoses. We undertook a systematic literature review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the PubMed, Web of Science, and Embase databases of the endovascular treatment options for CSS. Nine papers met the inclusion criteria and provided patient data on 12 patients, and one case illustration is presented. Treatment was with common carotid artery-external carotid artery stent graft without concomitant coil embolization in nine patients and with coil embolization without stenting, the breakthrough of the stump with a wire and subsequent internal carotid artery stent placement, and stent-assisted coil embolization in one patient each. During a median follow-up of six months, all patients were on dual antiplatelet therapy except one on undefined "systemic anticoagulation." Twelve patients had no symptoms after treatment, one had transient expressive aphasia but no further symptoms after being placed on anticoagulation, and none had intraprocedural complications or had to undergo retreatment. Our review indicates that endovascular treatment of CSS is associated with low intraprocedural risk and is effective at treating recurrent symptoms.
颈动脉残端综合征（CSS）是同侧复发性脑血管事件的罕见病因，通常表现为短暂性脑缺血发作或一过性黑矇。这些复发性症状的原因被认为是来自闭塞的颈内动脉的微栓塞，通过吻合支进入颅内循环。我们根据系统评价和Meta分析的首选报告项目（PRISMA）指南，使用PubMed、科学网和Embase数据库，对CSS的血管内治疗选择进行了系统的文献综述。9篇论文符合纳入标准，提供了12例患者的数据，并展示了1例病例。9例患者采用颈总动脉-颈外动脉支架植入术，未同时进行弹簧圈栓塞；1例患者采用单纯弹簧圈栓塞，未植入支架；1例患者采用钢丝穿透残端后植入颈内动脉支架；1例患者采用支架辅助弹簧圈栓塞。在中位随访6个月期间，除1例接受未明确的“全身抗凝治疗”外，所有患者均接受双联抗血小板治疗。12例患者治疗后无症状，1例出现短暂性表达性失语，抗凝治疗后未再出现其他症状，且均无术中并发症或需要再次治疗。我们的综述表明，CSS的血管内治疗术中风险低，对复发性症状的治疗有效。
