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"Stump" on internal carotid artery--a source for further cerebral embolic ischemia
Insights
Internal carotid artery occlusion can cause stroke and vision loss due to thromboembolism from the artery stump. Surgical intervention on the stump and associated arteries can prevent further ischemic events.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiovascular Medicine
Background:
- Internal carotid artery (ICA) occlusion can lead to ischemic events in the brain and retina.
- The mechanism of ischemia despite ICA occlusion is not fully understood.
Observation:
- Nine patients presented with hemisphere and retinal ischemia following ICA occlusion.
- Radiological and pathological findings revealed a persistent proximal stump with thrombotic material in most patients.
- Anastomotic supply through common and external carotid arteries was identified.
Findings:
- Thromboembolism originating from the ICA stump via anastomotic arteries is the likely cause of ischemic events.
- Turbulence within the stump contributes to atherosclerosis and thrombogenesis.
- Surgical management, including stump excision/obliteration and endarterectomy, was performed on seven patients.
Implications:
- Understanding stump-related thromboembolism is crucial for managing ICA occlusive disease.
- Surgical intervention can mitigate the risk of recurrent ischemic events.
- Further research into stump management strategies is warranted to improve patient outcomes.
Abstract:
A series of 9 patients have experienced hemisphere and retinal ischemia at an interval after occlusion of appropriate internal carotid arteries. All had radiological evidence of a persisting proximal stump to the occluded artery and, in most, pathological evidence of thrombotic material attached to atheromatous lesions within the stump. Thromboembolism from the stump via the anastomotic supply through ipsilateral common and external carotid arteries is thought to be responsible for the ischemic events to the brain or retina despite absence of flow through the internal carotid artery. Seven of the 9 were treated by surgical excision or obliteration of the stump and, when indicated, common and external carotid endarterectomy. Turbulence in the stump contributed to progressive atherosclerotic changes and probably aggravated thrombogenesis in this location with subsequent embolization into the anastomotic arteries.