Bilateral Internal Carotid and Left Vertebral Artery Dissection after Blunt Trauma: A Case Report and Literature Review

Abstract

Multi-vessel cervical arterial injury after blunt trauma is rare, and its pathophysiology is unclear. Although blunt cerebrovascular injury is a common cause of cerebral ischemia, its management is still controversial. We describe a 23-year-old man in previously good health who developed three-vessel cervical arterial dissections due to blunt trauma. He was admitted to our emergency and critical care center after a motor vehicle crash. Computed tomography showed a thin, acute subdural hematoma in the right hemisphere and fractures of the odontoid process (Anderson type III), pelvis, and extremities. He was treated conservatively, and about 1 month later, he developed bleariness. Computed tomography angiography showed bilateral internal carotid and left vertebral artery dissection. Aspirin therapy was started immediately, and then clopidogrel was added to the regimen. Two weeks later, magnetic resonance angiography (MRA) showed improved blood flow of the vessels. Only aspirin therapy was continued. About 3 months after discharge, MRA demonstrated further improvement of the blood flow of both internal carotid arteries, but the dissection flap on the right side remained. Therefore, we extended the duration of antiplatelet therapy. On the basis of our experience with this case, we think that antithrombotic therapy is crucial for the management of multi-vessel cervical arterial injury, and agents should be used properly according to the injury grade and phase; however, further study is needed to confirm this recommendation.

Vertebrobasilar and internal carotid arteries dissection in 188 patients

“…Two-vessel involvement was noticed in 11.7%, either both ICAs, both VAs, or VA and BA. The latter was reported in 18-25% of patients with blunt neck trauma, but less frequently in spontaneous dissections [1,38]. Three arteries were affected in 1.1% of our patients, i.e.…”

“…Since the ICA, VA and basilar artery (BA) dissections (ICAD and VBAD) are usually presented as case reports [6,37,38,[46][47][48][49][50][51][52][53][54][55][56] or as smaller groups of patients [1,8,27,36,41,43,[57][58][59][60][61][62][63], we decided to present them in a group of 188 patients. In addition to a detailed examination of each patient, a comparison between the ICAD and VBAD will be presented as well.…”

Vertebral artery injury in major trauma patients in Saudi Arabia: A retrospective cohort study

“…Bilateral injury to the cerebrovascular arteries occurs in 18-25% of patients with VAI. Only 9 case reports were published regarding blunt trauma to three or four cerebrovascular arteries 16 . The mortality due to blunt carotid injury is 13-38%, whereas the death due to VAI is about 8-18% 17 .…”

Endovascular treatment of blunt injury of the extracranial internal carotid artery: the prospect and dilemma

“…These injuries could be solitary or multiple, with one or more patterns of injury, and bilateral extracranial ICA could even be involved [9,[18][19][20].…”

“…Classical dissections include intramural hematomas, intimal tears and raised intimal flaps [8]. Intramural hematomas present with eccentric/ circumferential mural thickening extending along the long artery [18]. Intimal tears present with subtle mural thickening and contour irregularity, and raised intimal flaps present with a linear pattern of filling defect/false lumen opacification known as the ''double lumen'' sign and even pseudofenestration [41].…”