Abstract：
BACKGROUND: Stump syndrome is defined as a clinical syndrome resulting from a distal intracranial vessel embolic stroke due to an extracranial vessel occlusion. Similar to the anterior circulation, the recurrence of ischemic strokes in territories supplied by the posterior circulation in the presence of vertebral artery occlusion is termed Vertebral Artery Stump Syndrome (VASS).
METHODS: We conducted a literature review, identifying 72 patients with transient ischemic attacks (TIAs) or ischemic strokes attributed to VASS, according to Kawano criteria. We categorized all patients in two groups focusing on the therapeutic management those who underwent primary medical treatment and those who received endovascular or surgical treatment either in acute or chronic phase.
RESULTS: In the anticoagulant therapy group, only 1 patient had a stroke recurrence. Among the 4 on antiplatelets, all had recurrences, but 3 benefited from switching to anticoagulants or endovascular therapy. In the endovascular therapy group, worse outcomes were linked to acute large vessel occlusion. Endovascular treatment of the vertebral artery, in a chronic phase, was explored in literature for recurrent TIAs or minor strokes suggesting that this could be a viable therapeutic alternative when medical treatment failed in preventing recurrence of ischemic stroke.
CONCLUSIONS: Some studies suggest that anticoagulant medical therapy may be beneficial for VASS and endovascular therapy has also been reported for selected patients. However, data on treatment outcomes and prognosis are still underreported, making treatment decisions challenging. Randomized Controlled Trials are needed to establish the optimal treatment approach.
METHODS: We conducted a literature review, identifying 72 patients with transient ischemic attacks (TIAs) or ischemic strokes attributed to VASS, according to Kawano criteria. We categorized all patients in two groups focusing on the therapeutic management those who underwent primary medical treatment and those who received endovascular or surgical treatment either in acute or chronic phase.
RESULTS: In the anticoagulant therapy group, only 1 patient had a stroke recurrence. Among the 4 on antiplatelets, all had recurrences, but 3 benefited from switching to anticoagulants or endovascular therapy. In the endovascular therapy group, worse outcomes were linked to acute large vessel occlusion. Endovascular treatment of the vertebral artery, in a chronic phase, was explored in literature for recurrent TIAs or minor strokes suggesting that this could be a viable therapeutic alternative when medical treatment failed in preventing recurrence of ischemic stroke.
CONCLUSIONS: Some studies suggest that anticoagulant medical therapy may be beneficial for VASS and endovascular therapy has also been reported for selected patients. However, data on treatment outcomes and prognosis are still underreported, making treatment decisions challenging. Randomized Controlled Trials are needed to establish the optimal treatment approach.
摘要：
背景：残端综合征被定义为由颅外血管闭塞引起的远端颅内血管栓塞性卒中引起的临床综合征。类似于前循环，在存在椎动脉闭塞的情况下，由后循环提供的区域中缺血性中风的复发称为椎动脉残端综合征（VASS）。
方法：我们进行了文献综述，确定72例因VASS引起的短暂性脑缺血发作（TIA）或缺血性中风的患者，根据川野标准。我们将所有患者分为两组，重点是接受初级药物治疗的患者和接受急性或慢性期血管内或手术治疗的患者的治疗管理。
结果：在抗凝治疗组中，只有1例患者出现卒中复发.在4种抗血小板药物中，都有复发，但3例受益于改用抗凝剂或血管内治疗.在血管内治疗组中，更差的结果与急性大血管闭塞有关.椎动脉的血管内治疗，在慢性阶段，在文献中探讨了复发性TIA或轻度中风，这表明当药物治疗在预防缺血性中风复发方面失败时，这可能是可行的治疗选择。
结论：一些研究表明，抗凝药物治疗可能对VASS有益，并且还报道了一些患者的血管内治疗。然而,关于治疗结果和预后的数据仍然被低估，使治疗决策具有挑战性。需要随机对照试验来建立最佳治疗方法。
方法：我们进行了文献综述，确定72例因VASS引起的短暂性脑缺血发作（TIA）或缺血性中风的患者，根据川野标准。我们将所有患者分为两组，重点是接受初级药物治疗的患者和接受急性或慢性期血管内或手术治疗的患者的治疗管理。
结果：在抗凝治疗组中，只有1例患者出现卒中复发.在4种抗血小板药物中，都有复发，但3例受益于改用抗凝剂或血管内治疗.在血管内治疗组中，更差的结果与急性大血管闭塞有关.椎动脉的血管内治疗，在慢性阶段，在文献中探讨了复发性TIA或轻度中风，这表明当药物治疗在预防缺血性中风复发方面失败时，这可能是可行的治疗选择。
结论：一些研究表明，抗凝药物治疗可能对VASS有益，并且还报道了一些患者的血管内治疗。然而,关于治疗结果和预后的数据仍然被低估，使治疗决策具有挑战性。需要随机对照试验来建立最佳治疗方法。
