Authors
Takao Koiso, Yoshiyuki Kitayama, Chihiro Watanabe, Shuichi Mori, Masahiro Iguchi, Yuji Matsumaru
Published in
Surgical neurology international. Volume 17. Pages 457. Epub Aug 14, 2026.
Abstract
Kommerell diverticulum frequently requires thoracic endovascular aortic repair (TEVAR) with carotid-subclavian bypass (CSB). Although CSB is durable, delayed embolic stroke secondary to graft failure is rare. We report a rare case of large vessel occlusion caused by a stump-related embolism from an occluded CSB.
A 34-year-old man with a history of deep vein thrombosis under warfarin therapy developed right hemiplegia and aphasia 85 days after TEVAR and left CSB for Kommerell diverticulum. Upon admission, physical examination revealed a marked inter-arm blood pressure difference (40-mmHg drop in the left arm). Initial laboratory testing showed a subtherapeutic international normalized ratio of 1.7. Magnetic resonance imaging demonstrated left internal carotid artery terminus occlusion. Angiography revealed complete occlusion of the CSB with a 2-cm blind-ended stump distal to the carotid anastomosis, showing significant contrast stagnation. Mechanical thrombectomy achieved complete reperfusion. Strict antithrombotic management prevented recurrence.
A thrombosed CSB can act as a dangerous embolic source through a mechanism analogous to carotid stump syndrome. Careful long-term vascular surveillance and bedside monitoring of inter-arm blood pressure differences are vital for early detection of graft dysfunction.
PMID:
42694799
Bibliographic data and abstract were imported from PubMed on 04 Sep 2026.
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