Carotid stump syndrome: A case report

Area of Science:

• Neurology
• Vascular Surgery
• Ophthalmology

Background:

• Carotid stump syndrome (CSS) is a recognized cause of recurrent ipsilateral ischemic stroke after internal carotid artery (ICA) occlusion.
• Microemboli originating from the occluded ICA stump can lead to ischemic events.

Purpose of the Study:

• To describe a case of left CSS presenting as central retinal artery embolism.
• To explore the pathophysiology of CSS-induced retinal artery embolism via anastomotic channels.
• To report the treatment outcome for this CSS case.

Main Methods:

• Case report of a 50-year-old patient with left CSS and central retinal artery embolism.
• Digital subtraction angiography to visualize ICA stump flow and potential anastomotic channels.
• Evaluation of potential pathophysiological mechanisms for emboli transport.

Main Results:

• The patient presented with central retinal artery embolism secondary to left ICA and middle cerebral artery occlusion.
• Angiography revealed trickle flow in the occluded ICA, suggesting a pathway for emboli to the ophthalmic artery via external carotid-internal carotid anastomoses.
• Successful treatment was achieved with anticoagulation therapy alone.

Conclusions:

• CSS can manifest as retinal artery embolism due to microemboli from the ICA stump.
• External carotid-internal carotid anastomotic channels may facilitate emboli transport to the ophthalmic artery.
• Anticoagulation therapy can be an effective treatment for CSS-related retinal artery embolism.