Stenos Christos, Anastasiou Aikaterini, Nikolopoulou Georgia, Papanagiotou Panagiotis, Papagiannis Georgios, Koutroumpi Aikaterini, Drakopoulou Danai, Anastasiou Periklis, Yiannopoulou Konstantina
2nd Neurological Department, Henry Dunant Hospital Center, 11526 Athens, Greece.
Department of Neuroradiology, University Hospital Basel, 4031 Basel, Switzerland.
Diagnostics (Basel). 2025 May 17;15(10):1273. doi: 10.3390/diagnostics15101273.
Carotid stump syndrome (CSS) is a rare and unexpected cause of recurrent ischemic ipsilateral events in the carotid vascular territory despite the demonstrated occlusion of the internal carotid artery (ICA). It is believed to be caused by microemboli due to turbulent blood flow in the patent stump of the occluded ICA that passes through anastomotic channels and retrograde flow into the middle cerebral artery circulation. We describe the case of a 65-year-old male patient who suffered multiple concurrent transient ischemic attacks (TIAs) with a totally occluded ipsilateral ICA revealed by computed tomography angiography (CTA). He was diagnosed with CSS, which required the safest therapeutic approach. A further investigation with digital subtraction angiography (DSA) was performed, and a trickle of blood flow was observed in the reportedly occluded ICA. The diagnosis of a true ICA occlusion was withdrawn, and a diagnosis of pseudo-occlusion was established, affecting the final treatment strategy. Therefore, the patient underwent an ipsilateral carotid endarterectomy (CEA), and he has remained asymptomatic since then. The differentiation between a pseudo-occlusion and a true ICA occlusion is essential in promptly managing acute recurrent ipsilateral ischemic strokes in the carotid vascular territory. A further investigation with DSA in cases with a totally occluded ICA using CTA is essential for excluding pseudo-occlusions in ipsilaterally symptomatic patients.
颈动脉残端综合征（CSS）是颈动脉血管区域反复出现同侧缺血性事件的一种罕见且意想不到的原因，尽管已证实颈内动脉（ICA）闭塞。据信，它是由闭塞的ICA残端中血流紊乱产生的微栓子引起的，这些微栓子通过吻合通道并逆向流入大脑中动脉循环。我们描述了一例65岁男性患者的病例，该患者同时发生多次短暂性脑缺血发作（TIA），计算机断层血管造影（CTA）显示同侧ICA完全闭塞。他被诊断为CSS，这需要最安全的治疗方法。进一步进行了数字减影血管造影（DSA）检查，在据报道闭塞的ICA中观察到少量血流。撤回了真正ICA闭塞的诊断，确立了假性闭塞的诊断，这影响了最终的治疗策略。因此，该患者接受了同侧颈动脉内膜切除术（CEA），此后一直无症状。在颈动脉血管区域及时处理急性复发性同侧缺血性卒中时，区分假性闭塞和真正的ICA闭塞至关重要。对于使用CTA显示ICA完全闭塞的病例，进一步进行DSA检查对于排除同侧有症状患者的假性闭塞至关重要。
