Exploring Vertebral Artery Stump Syndrome: An overlooked Cause of Posterior Ischemic Strokes. A Narrative Review of Current Management Options.

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). 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. 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. 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.

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Déclaration de conflit d'intérêts

Declaration of competing interest We declare that we have no conflicts of interest to disclose regarding the manuscript entitled "Vertebral Artery Stump Syndrome: A Comprehensive Review of Diagnosis and Management," submitted for consideration for publication in Journal of Stroke Cerebrovascular Disease. We have no financial interests, research funding, employment or leadership roles, intellectual property rights, consultancies, or personal relationships that could potentially influence or be perceived to influence the content of this manuscript. We affirm that the work is original, has not been previously published or submitted elsewhere, and that we have not received any financial support or compensation for the preparation, writing, or submission of this manuscript.