Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: results in 234 cases

Higashida, R T; Vv, Halbach; Tsai, F Y; Norman, David; Pribram, HF; Mehringer, C M; Hieshima, Grant B.

doi:10.2214/ajr.153.3.577

Cited by 251 publications

(130 citation statements)

References 7 publications

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“…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.

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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...

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Section: Discussionmentioning

confidence: 99%

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Wei

Montanera

Selchen

et al. 2010

Can. j. neurol. sci.

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“…The direct surgical approach to the vertebral artery, on the other hand, also becomes extremely difficult and results in high risks due to the extensive periarterial plexus, a number of sources of collateral circulation, anatomical site and the risk of ischaemic attack and infarction of the vertebrobasilar system during its manipulation 3,10,16 . Recently, interventional neuroradiology employing endovascular techniques under local anesthesia has been described" 1,26 , with excellent results, and alterations in the neurological status of the patient may be observed when the vertebral artery is temporarily occluded using the balloon. This technique should always be considered for the resolution of these lesions because it reduces risks of surgery and its complications, by diminishing the hospital stay, as occurred in this report.…”

Section: Discussionmentioning

confidence: 99%

Giant pseudoaneurysm of the extracranial vertebral artery: case report

Gallo

Dalacorte

Raupp

et al. 1996

Arq. Neuro-Psiquiatr.

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-Pseudoaneurysms of the extracranial vertebral artery are extremely rare due to their deep location and the anatomical protection of this artery. They can be caused by cervical traumas (firearm injuries, sports, hyperextension of the neck and iatrogeny). The authors report the case of a patient who developed a giant pseudoaneurysm of the extracranial vertebral artery after surgery for the removal of a tumor of the cerebellopontine angle in which surgical lesion of the artery occurred. Treatment was performed by endovascular approach. Literature is reviewed and comments are made on the physiopathogeny of the lesion and the different forms of treatment. KEY WORDS: aneurysm, vertebral artery aneurysm.endovascular treatmentPseudoaneurisma gigante da artéria vertebral extracraniana: relato de caso RESUMO -Os pseudoaneurismas da artéria vertebral extracraniana são extremamente raros pela localização profunda e proteção anatômica desta artéria. Podem ser ocasionados por traumas cervicais (ferimentos por armas de fogo, esportes, hiperextensão do pescoço e iãtrogenias). Os autores relatam o caso de um paciente que desenvolveu um pseudoaneurisma gigante da artéria vertebral extracraniana após cirurgia para retirada de tumor de ângulo ponto cerebelar em que ocorreu a lesão cirúrgica desta artéria e cujo tratamento foi endovascular. A literatura é revisada e são feitas considerações sobre a fisiopatogenia da lesão e as várias formas de tratamento. PALAVRAS-CHAVE: aneurisma, aneurisma da artéria vertebral, tratamento endovascularPseudoaneurysms of the extracranial vertebral artery are rare lesions 5 -36 since this artery is anatomically protected 20 . The initial description was made by Matas in 1893 32 , and there are few reports of iatrogenic pseudoaneurysms. The resolution of these lesions is rather controversial, always with a high degree of difficulty and various rates of morbidity and mortality 3 '

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“…Higashida et al [15] reported preservation of the parent artery in 88% of patients with TCCFs treated by using detachable balloons; other authors have described a need for parent artery occlusion in as many as 20% of cases [16,17].…”

Section: Review Of Endovascular Management Of Traumatic Carotid-cavermentioning

confidence: 99%

Traumatic Middle Meningeal Artery and Fistula Formation with the Cavernous Sinus and a Review of the Literature on Endovascular Management of Traumatic Carotid Cavernous Fistulas

Lv¹,

Li²,

Jiang³

2013

Arteriovenous Fistulas - Diagnosis and Management

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Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: results in 234 cases

Abstract: InterventionalNeuroradiology Section, 505 Pamassus Ave., L-352, San Francisco, CA 941 43. Address reprint requests to A. T. Higashida.

Cited by 251 publications

References 7 publications

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Giant pseudoaneurysm of the extracranial vertebral artery: case report

Traumatic Middle Meningeal Artery and Fistula Formation with the Cavernous Sinus and a Review of the Literature on Endovascular Management of Traumatic Carotid Cavernous Fistulas

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