Cerebral artery stump syndrome: a comprehensive pooled analysis of 188 angiographically confirmed cases.

Introduction: Cerebral artery stump syndrome (CASS), a rare aetiology of ischemic stroke, consists of two subtypes: carotid stump syndrome (CSS) and vertebral artery stump syndrome (VASS). It causes recurrent ischemic events due to thrombus formation. However, selection of therapeutic strategies remains controversial, and large-sample systematic evaluations are lacking. Methods: Relevant literature from PubMed, Embase, and China Biomedical Literature Database (inception to 15 September 2025) were retrieved. Angiography-confirmed case reports and case series of CASS were included. Data on baseline characteristics, clinical features, treatment, and prognosis were extracted. Additionally, three typical cases from our institution were enrolled. Differences in clinical features and recurrence were analyzed. A two-tailed test was performed, with Results: A total of 188 patients (CSS = 103, VASS = 85) from 43 studies were included. Therapeutic modality was the key factor associated with disease recurrence. The recurrence rate with medical treatment alone (19.0%) was significantly higher than that with invasive treatments, including carotid endarterectomy (1.7%), endovascular embolization (0.0%), external carotid stenting (0.0%), and endovascular recanalization (5.4%) ( Conclusion: This study confirmed that embolus source occlusion is central to CASS treatment. Invasive treatment was associated with a lower recurrence rate than medical treatment alone, and anticoagulation was the first choice of medical treatment. Subtype-specific individualized diagnosis and treatment should be implemented for CSS and VASS. This study provides evidence for standardized clinical diagnosis and treatment of CASS.