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Published on: October 20, 2017
Cerebral artery stump syndrome: a comprehensive pooled analysis of 188 angiographically confirmed cases
Ping Lu1, Ling-Yun Cui2, Yi Jin1
1Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
Insights
Cerebral artery stump syndrome (CASS) treatment focuses on embolus source occlusion. Invasive therapies significantly reduce recurrence compared to medical management alone, with anticoagulation being the preferred medical approach.
Area of Science:
- Neurology
- Vascular Surgery
- Stroke Medicine
Background:
- Cerebral artery stump syndrome (CASS) is a rare cause of ischemic stroke, encompassing carotid stump syndrome (CSS) and vertebral artery stump syndrome (VASS).
- It is characterized by recurrent ischemic events stemming from thrombus formation.
- Current therapeutic strategies lack consensus, and large-scale systematic evaluations are limited.
Purpose of the Study:
- To systematically evaluate therapeutic strategies for Cerebral Artery Stump Syndrome (CASS).
- To compare recurrence rates between different treatment modalities for CSS and VASS.
- To provide evidence for standardized clinical diagnosis and treatment of CASS.
Main Methods:
- A systematic literature review was conducted across PubMed, Embase, and China Biomedical Literature Database.
- Angiography-confirmed case reports and case series of CASS were included.
- Data on patient characteristics, clinical features, treatments, and outcomes were extracted and analyzed.
Main Results:
- A total of 188 patients (103 CSS, 85 VASS) from 43 studies were analyzed.
- Invasive treatments (carotid endarterectomy, endovascular embolization, stenting, recanalization) showed significantly lower recurrence rates (0.0%-5.4%) than medical treatment alone (19.0%).
- Among medical treatments, anticoagulation (42.1% recurrence) was more effective than antiplatelet therapy (93.0% recurrence).
Conclusions:
- Embolus source occlusion is critical for managing CASS.
- Invasive treatments are associated with lower recurrence rates than medical management alone.
- Anticoagulation is the preferred medical treatment, and individualized, subtype-specific approaches are recommended for CSS and VASS.
Introduction:
Cerebral artery stump syndrome (CASS), a rare aetiology of ischemic stroke, consists of two subtypes: carotid stump syndrome (CSS) and vertebral artery stump syndrome (VASS). It causes recurrent ischemic events due to thrombus formation. However, selection of therapeutic strategies remains controversial, and large-sample systematic evaluations are lacking.
Methods:
Relevant literature from PubMed, Embase, and China Biomedical Literature Database (inception to 15 September 2025) were retrieved. Angiography-confirmed case reports and case series of CASS were included. Data on baseline characteristics, clinical features, treatment, and prognosis were extracted. Additionally, three typical cases from our institution were enrolled. Differences in clinical features and recurrence were analyzed. A two-tailed test was performed, with p < 0.05 considered statistically significant.
Results:
A total of 188 patients (CSS = 103, VASS = 85) from 43 studies were included. Therapeutic modality was the key factor associated with disease recurrence. The recurrence rate with medical treatment alone (19.0%) was significantly higher than that with invasive treatments, including carotid endarterectomy (1.7%), endovascular embolization (0.0%), external carotid stenting (0.0%), and endovascular recanalization (5.4%) (p = 0.015). In the medical treatment alone subgroup, the recurrence rate with initial anticoagulant therapy was 42.1%, which was substantially lower than that with antiplatelet therapy (93.0%).
Conclusion:
This study confirmed that embolus source occlusion is central to CASS treatment. Invasive treatment was associated with a lower recurrence rate than medical treatment alone, and anticoagulation was the first choice of medical treatment. Subtype-specific individualized diagnosis and treatment should be implemented for CSS and VASS. This study provides evidence for standardized clinical diagnosis and treatment of CASS.
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