Endovascular Treatment of Traumatic Injuries of the Vertebral Artery

Herrera, Diego A.; Vargas, Susana; Dublin, Arthur B.

doi:10.3174/ajnr.a1123

Cited by 87 publications

(104 citation statements)

References 19 publications

(30 reference statements)

Supporting

Mentioning

100

Contrasting

Unclassified

Order By: Relevance

“…Endovascular techniques such as coil embolization and stent placement have gained increasing popularity in the treatment of blunt vascular injuries including pseudoaneurysm, fistula, and flow-limiting dissections. While some studies have raised concerns over the safety of endovascular techniques as a result of increased risks of stroke and stent occlusion 17,27,34 , other groups have reported good longterm results with endovascular treatment [35][36][37][38] . Specifically, endovascular occlusion has been advocated as a feasible and safe treatment for traumatic vertebral arteriovenous fistula 39,40 .…”

Section: Discussionmentioning

confidence: 99%

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Wei

Montanera

Selchen

et al. 2010

Can. j. neurol. sci.

View full text Add to dashboard Cite

574In recent years, blunt cerebrovascular injury (BCVI) is gaining attention as an important sequela of nonpenetrating trauma to the neck and skull base. Blunt cerebrovascular injury affects approximately 1% of all blunt trauma admissions, and the reported incidence is as high as 2.7% in centres with aggressive screening protocols [1][2][3][4][5][6][7][8] . The pattern of BCVI consists of vascular transection, dissection, thrombosis, and formation of pseudoaneurysm or arteriovenous fistula (AVF) 9,10 . The majority of these injuries occur during motor vehicle accidents, with variable rates of carotid and vertebral artery involvement reported in the literature [11][12][13] . If untreated, BCVI can be fatal and result in devastating neurological sequelae, with mortality and morbidity rates reported up to 38% and 67% respectively 14 .One of the difficulties in initiating treatment for BCVI is related to the variable symptomatology. While approximately ABSTRACT: Background: Blunt cerebrovascular injury (BCVI) to the carotid and vertebral arteries is a potentially devastating injury in trauma patients. The optimal management for BCVI has not been standardized. At our institution, 64-slice multi-detector computed tomographic angiography (CTA) has been used as the initial screening exam for BCVI in patients who met predefined screening criteria. The purpose of this study is to review the incidence of CTA-diagnosed BCVI in at-risk patients and to evaluate the treatment and clinical outcome of patients with BCVI. Methods: This study included trauma patients with a positive diagnosis of BCVI on CTA during a 41-month study period. The medical records and relevant radiographic findings were retrospectively reviewed. Results: Twenty seven of 222 blunt trauma patients evaluated with CTA had a positive diagnosis of BCVI, with an occurrence rate of 12.2%. Traumatic brain injury (72.2%) and basal skull fractures (55.6%) were the most frequent associated injuries with carotid trauma while 100% of blunt vertebral injuries occurred in the setting of cervical fractures. Fourteen (51.8%) patients received medical therapy; Eleven (40.7%) patients received conservative treatment. Endovascular treatment was attempted in a single case of vertebral arteriovenous fistula. BCVI-related stroke was found in four patients (14.8%), one of whom developed an infarct while on medical treatment. Conclusions: BCVI is found in a significant portion of blunt trauma patients with identifiable risk factors, and screening CTA has high diagnostic yield in detecting these lesions. Medical therapy is the mainstay of treatment at our institution; however, BCVI-related stroke may occur despite treatment. RÉSUMÉ: Diagnostic et résultats du traitement des traumatismes cérébrovasclaires contondants. Contexte :Le traumatisme cérébrovasculaire contondant (TCVC) à la carotide et aux artères vertébrales est une lésion qui peut être dévastatrice chez les patients qui ont subi un traumatisme. Le traitement optimal du TCVC n'a pas été standardisé. Dans notre institutio...

show abstract

Section: Discussionmentioning

confidence: 99%

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Wei

Montanera

Selchen

et al. 2010

Can. j. neurol. sci.

View full text Add to dashboard Cite

show abstract

“…The disorder may result in vertebrobasilar ischemia, vertigo, diplopia and cephalgia due to arterial steal. Venous hypertension of dilated epidural veins caused by blood flow to spinal veins may result in root compression, pain and myelopathy (8,12). We showed an AVF at the left vertebral artery where the vertebrobasilar system could not filled via left catheterization, but filled with right catheterization via the right posterior communicating artery (steal phenomenon) in our case.…”

Section: Yilmaz Mb Et Al: Penetrating Vertebral Artery Injurymentioning

confidence: 70%

“…Traumatic fistulas are mostly seen at the second part of the artery where it courses within the foramen transversarium (26). Although most cases have been reported below the C5 level, Herrera et al have found the majority of traumatic fistulas between C2-5 in their series (12). This is due to the high incidence of traumatic cervical injuries at the C2-5 levels.…”

Section: Yilmaz Mb Et Al: Penetrating Vertebral Artery Injurymentioning

confidence: 91%

“…A fistula may arise between the extracranial branch of the vertebral artery and surrounding venous structures or radicular and muscular branches. Nearly 30% of AVFs are asymptomatic and diagnosed incidentally by auscultation of the bruit at the neck (2,12). The disorder may result in vertebrobasilar ischemia, vertigo, diplopia and cephalgia due to arterial steal.…”

Section: Yilmaz Mb Et Al: Penetrating Vertebral Artery Injurymentioning

confidence: 99%

See 1 more Smart Citation

Vertebrojugular arterio-venous fistula and psudo-aneurism formation due to penetrating vertebral artery injury: case report and review of the literature

Yılmaz

Dönmez²,

Tönge³

et al. 2013

Turkish Neurosurgery

View full text Add to dashboard Cite

Vertebral artery injury including thrombosis, arteriovenous fistula (AVF), pseudo-aneurysm and hemorrhage may be iatrogenic or due to penetrating or blunt trauma. Although mostly asymptomatic, vertebral artery injury may also present with vertebrobasilar insufficiency findings, cephalgia, radicular pain or myelopathy due to blockade of arterial flow, arterial steal phenomenon and venous hypertension. The gold standard for diagnosis is digital subtraction angiography (DSA). Doppler ultrasonography, magnetic resonance-angiography and computerized tomography-angiography are also helpful. Endovascular treatment is now used more commonly. We present a case with sharp bread knife injury of the vertebral artery that was also complicated with a vertebrojugular fistula and pseudo-aneurysm together with the diagnostic and management options and a review of the current literature.

show abstract

“…The sensitivity for detecting extracranial vertebral artery dissection was estimated around 75% in literature. Anyway the distal V2 and V3 segments cannot always be satisfactorily imaged; therefore, diagnosis is based on indirect hemodynamic signs [20][21][22][23]. Whereas angiography only shows an alteration of the vessel lumen, duplex color-flow imaging provides additional information about the hemodynamic parameters and the pathology of the vessel wall.…”

Section: Discussionmentioning

confidence: 99%

What does Doppler Ultrasonography Brings to the Diagnosis of Traumatic Vertebral Artery Dissection

Caruso¹,

Manganotti²

2016

J Clin Case Rep

View full text Add to dashboard Cite

Here we describe the case of a young woman with a late diagnosis of vertebral artery dissection and midbrain ischemic lesion after minor post traumatic injury. Doppler ultrasonography was used as the first diagnostic examination to evaluate the dissection. We present this unusual but not rare case related to the frequent events of cervical distraction after car accident in order to better understand the clinical approach the sensitivity Doppler ultrasonography in post-traumatic cervical distorsion.

show abstract

Endovascular Treatment of Traumatic Injuries of the Vertebral Artery

Abstract: BACKGROUND AND PURPOSE:There are a few reports regarding the treatment of traumatic vertebral arteriovenous fistulas and pseudoaneurysms. Our aim was to describe the clinical and angiographic results of endovascular therapy for traumatic injuries of the vertebral artery.

Cited by 87 publications

References 19 publications

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Vertebrojugular arterio-venous fistula and psudo-aneurism formation due to penetrating vertebral artery injury: case report and review of the literature

What does Doppler Ultrasonography Brings to the Diagnosis of Traumatic Vertebral Artery Dissection

Contact Info

Product

Resources

About