Research Article| Volume 324, ISSUE 1-2, P74-79, January 15, 2013

Vertebral artery stump syndrome in acute ischemic stroke

Published:October 29, 2012DOI:


      Although the carotid artery stump as an embolic source for ischemic stroke has been well described, there have been few systematic reports of a similar syndrome in the posterior circulation (PC) after vertebral artery (VA) origin occlusion. The aim of this study was to identify the incidence and characteristics of acute ischemic stroke with VA stump syndrome. Of 3463 consecutive patients who were admitted within 7 days after onset, 865 patients with acute ischemic stroke in the PC were enrolled. The diagnostic criteria of VA stump syndrome included: (1) acute ischemic stroke in the posterior circulation; (2) the VA origin occlusion identified on MRA, duplex ultrasound, CT angiography, and/or conventional angiography; (3) presence of distal antegrade flow in the ipsilateral VA; and (4) absence of other causes of ischemic stroke. Of the 865 patients with PC stroke, 12 (1.4%) were diagnosed as having VA stump syndrome. The ischemic lesions included the cerebellum in all patients. Nine patients had multiple ischemic lesions in the brain stem, thalamus, or posterior lobe other than cerebellum. On duplex ultrasound, a to-and-fro flow pattern was observed in the culprit VA in 10 patients. Three patients had recurrences of ischemic stroke in the PC during the acute phase. VA stump syndrome was not a rare mechanism of PC stroke, and there was a high rate of stroke recurrence during the acute phase. Vascular assessment by a multimodality approach can be used to promptly detect VA stump syndrome.


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        • Barnett H.J.
        • Peerless S.J.
        • Kaufmann J.C.
        “Stump” on internal carotid artery — a source for further cerebral embolic ischemia.
        Stroke. 1978; 9: 448-456
        • Barnett H.J.
        Delayed cerebral ischemic episodes distal to occlusion of major cerebral arteries.
        Neurology. 1978; 28: 769-774
        • Quill D.S.
        • Colgan M.P.
        • Sumner D.S.
        Carotid stump syndrome: a colour-coded Doppler flow study.
        Eur J Vasc Surg. 1989; 3: 79-83
        • Nguyen T.N.
        • Raymond J.
        • Mahmoud M.
        • Weill A.
        • Roy D.
        • Guilbert F.
        Vertebral artery stump syndrome.
        J Neurol Neurosurg Psychiatry. 2008; 79: 91-92
        • Kawano H.
        • Inatomi Y.
        • Hirano T.
        • Yonehara T.
        • Uchino M.
        Anticoagulation therapy for vertebral artery stump syndrome.
        J Neurol Sci. 2010; 295: 125-127
        • Caplan L.R.
        • Amarenco P.
        • Rosengart A.
        • Lafranchise E.F.
        • Teal P.A.
        • Belkin M.
        • et al.
        Embolism from vertebral artery origin occlusive disease.
        Neurology. 1992; 42: 1505-1512
        • Nagahata M.
        • Abe Y.
        • Ono S.
        • Hosoya T.
        • Uno S.
        Surface appearance of the vertebrobasilar artery revealed on basiparallel anatomic scanning (BPAS)-MR imaging: its role for brain MR examination.
        AJNR Am J Neuroradiol. 2005; 26: 2508-2513
        • Adams Jr., H.P.
        • Bendixen B.H.
        • Kappelle L.J.
        • Biller J.
        • Love B.B.
        • Gordon D.L.
        • et al.
        Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.
        Stroke. 1993; 24: 35-41
        • Lyden P.
        • Brott T.
        • Tilley B.
        • Welch K.M.
        • Mascha E.J.
        • Levine S.
        • et al.
        Improved reliability of the NIH Stroke Scale using video training.
        Stroke. 1994; 25: 2220-2226
        • van Swieten J.C.
        • Koudstaal P.J.
        • Visser M.C.
        • Schouten H.J.
        • van Gijn J.
        Interobserver agreement for the assessment of handicap in stroke patients.
        Stroke. 1988; 19: 604-607
        • Kyrle P.A.
        • Eichinger S.
        Is Virchow's triad complete?.
        Blood. 2009; 114: 1138-1139
        • Searls D.E.
        • Caplan L.R.
        • Safdar A.
        • Kumar S.
        Vertebral artery origin thrombus in a patient with cerebellar infarct.
        Arch Neurol. 2008; 65: 1386-1387
        • Kotval P.S.
        • Babu S.C.
        • Shah P.M.
        Doppler diagnosis of partial vertebral/subclavian steals convertible to full steals with physiologic maneuvers.
        J Ultrasound Med. 1990; 9: 207-213
        • Buckenham T.M.
        • Wright I.A.
        Ultrasound of the extracranial vertebral artery.
        Br J Radiol. 2004; 77: 15-20
        • Hua Y.
        • Meng X.F.
        • Jia L.Y.
        • Ling C.
        • Miao Z.R.
        • Ling F.
        • et al.
        Color Doppler imaging evaluation of proximal vertebral artery stenosis.
        AJR Am J Roentgenol. 2009; 193: 1434-1438
        • Horrow M.M.
        • Stassi J.
        Sonography of the vertebral arteries: a window to disease of the proximal great vessels.
        AJR Am J Roentgenol. 2001; 177: 53-59
        • Saito K.
        • Kimura K.
        • Nagatsuka K.
        • Nagano K.
        • Minematsu K.
        • Ueno S.
        • et al.
        Vertebral artery occlusion in duplex color-coded ultrasonography.
        Stroke. 2004; 35: 1068-1072