Carotid stump syndrome: Outcome from surgical management

Objectives: in patients with occluded internal cartoid arteries the cartoid stump is a potential source of microemboli resulting in the persistence of retinal or cerebral ischaemic symptoms. We report 25 patients who had pers istent cerebral and retinal ischaemic symptoms with an occluded ipsilateral ICA and a cartoid stump who underwent surgical exclusion of the stump. Methods: between January 1988 and January 1998, 322 patients underwent cart oid stump endarterectomy. Twenty-five patients (20 males: five females; mea n age 58,9 (range 44-78 years)) had cartoid stump exclusion. Indications fo r surgery were transient ischaemic attack (22), amaurosis fugax (eight) and cerebrovascular accident (13). Three patients had undergone contralateral cartoid endarterectomy and 12 had significant contralateral stenosis. Twent y patients were being treated with aspirin and four with warfarin at the ti me of presentation. Results: the diagnosis of cartoid stump was made in 22 patients by angiogra phy. In the remaining three patients duplex alone was diagnostic in two pat ients. In the third case duplex was combined with magnetic resonance angiog raphy (MRA) to confirm the diagnosis. Stump exclusion was carried out by ov ersewing the ICA origin. All but one patient remained symptom free at follo w-up. Conclusion: cartoid stump syndrome should be considered as a likely clinica l entity in patients with an occluded ICA and persisting cerebral and retin al microembolic symptoms. Surgical exclusion of the cartoid stump is a safe and effective method of treatment.