title: Safety and efficacy of surgical treatment of carotid stump syndrome: pilot study.
abstract: Surgical exclusion of the internal carotid artery (ICA) stump combined with endarterectomy of the external carotid artery is an established treatment approach. The aim of this pilot study was to compare the risk of cerebrovascular events between surgical treatment and best medical treatment in patients with ICA occlusion and carotid stump syndrome. Forty patients (23 males; age: 43-80 years; mean age: 61.1 ± 9.0 years) with carotid occlusion and carotid stump syndrome were enrolled. Ten patients with asymptomatic ICA occlusion and 10 patients with symptomatic ICA occlusion and carotid stump syndrome were enrolled to the best medical therapy group. Patients with chronic ICA occlusion, carotid stump syndrome, and one (15 patients) or recurrent (three patients) episodes of ipsilateral stroke or transient ischemic attack were enrolled to the surgical group. Neurological examination was undertaken on the day of randomization and then every 6 months in all patients for 4 years. All vascular events and death were recorded. Only one vascular event occurred in patients with symptomatic ICA occlusion without recurrent stroke or transient ischemic attack who were treated medically. No other vascular event was noted in the other subgroups. One patient with symptomatic carotid occlusion without recurrent stroke died due to myocardial infarction 6 months after surgery. Surgical treatment of carotid stump syndrome seems to be a safe procedure. Nevertheless, the benefit of a surgical approach in comparison with the best medical treatment is not clear.
authors.affiliation: Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Hrbáč
authors.forename: Vladimír
authors.initials: V
authors.lastname: Beneš
authors.forename: Pavel
authors.initials: P
authors.lastname: Širůček
authors.forename: Tomáš
authors.initials: T
authors.lastname: Jonszta
authors.forename: Roman
authors.initials: R
authors.lastname: Herzig
authors.forename: Václav
authors.initials: V
authors.lastname: Procházka
authors.forename: David
authors.initials: D
authors.lastname: Skoloudík
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002342:Carotid Artery, External / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D018153:Czech Republic; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D013577:Syndrome; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome