{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T07:28:57Z","timestamp":1786692537745,"version":"build-2736575974"},"reference-count":5,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Kommerell diverticulum frequently requires thoracic endovascular aortic repair (TEVAR) with carotid\u2013subclavian 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.<\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_748_2026","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T06:53:29Z","timestamp":1786690409000},"page":"457","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stump-related embolism from a thrombosed carotid\u2013subclavian bypass causing large vessel occlusion after thoracic endovascular aortic repair"],"prefix":"10.25259","volume":"17","author":[{"given":"Takao","family":"Koiso","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Mito Saiseikai General Hospital, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Kitayama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mito Saiseikai General Hospital, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chihiro","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mito Saiseikai General Hospital, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuichi","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mito Saiseikai General Hospital, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Iguchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mito Saiseikai General Hospital, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Matsumaru","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Stroke, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"10.25259\/SNI_748_2026\/ref-1","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1161\/01.STR.9.5.448","article-title":"\u201cStump\u201d on internal carotid artery\u2014a source for further cerebral embolic ischemia","volume":"9","author":"Barnett","year":"1978","journal-title":"Stroke"},{"key":"10.25259\/SNI_748_2026\/ref-2","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1067\/mva.2000.108012","article-title":"Kommerell\u2019s diverticulum and aneurysmal right-sided aortic arch: a case report and review of the literature","volume":"32","author":"Cin\u00e0","year":"2000","journal-title":"J Vasc Surg"},{"key":"10.25259\/SNI_748_2026\/ref-3","doi-asserted-by":"crossref","first-page":"721","DOI":"10.21470\/1678-9741-2021-0597","article-title":"Mid-term results of left carotid-subclavian bypass in patients undergoing zone 2 TEVAR","volume":"37","author":"Ince","year":"2022","journal-title":"Braz J Cardiovasc Surg"},{"key":"10.25259\/SNI_748_2026\/ref-4","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1016\/j.jvs.2009.08.090","article-title":"The Society for Vascular Surgery practice guidelines: management of the left subclavian artery with thoracic endovascular aortic repair","volume":"50","author":"Matsumura","year":"2009","journal-title":"J Vasc Surg"},{"key":"10.25259\/SNI_748_2026\/ref-5","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1177\/000331979804900406","article-title":"Carotidsubclavian bypass for subclavian artery revascularization: Long-term follow-up and effect of antiplatelet therapy","volume":"49","author":"Wittwer","year":"1998","journal-title":"Angiology"}],"container-title":["Surgical Neurology 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