Single-center experience on endovascular reconstruction of traumatic internal carotid artery dissections

José E. Cohen, John M. Gomori, Eyal Itshayek, Sergey Spektor, Yigal Shoshan, Guy Rosenthal, Samuel Moscovici

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

BACKGROUND: Traumatic internal carotid artery dissection (CAD) has a potentially grave outcome. Anticoagulant therapy may be ineffective or contraindicated; surgery impractical. We present our experience with endovascular stenting in CAD patients. METHODS: From 2004 to 2011, 23 patients with angiographically proven traumatic CAD underwent endovascular stent-assisted arterial reconstruction based on clinical and radiographic criteria: contraindication or failure of anticoagulation, evidence of impending ischemic stroke, or need for urgent intracranial revascularization. Dissections were graded based on degree of stenosis and extent of injury. RESULTS: Seventeen patients (73.9%) presented with stroke or transient ischemic attack. Carotid revascularization was achieved with one (11 patients, 48%) or multiple stents (12 patients, 52%); distal protection was used rarely (three patients, 13%). No complications were directly attributed to stenting. Mean dissection-related stenosis improved from 72%± 28.87%to 4%± 8.29%. At a mean clinical follow-up of 28.7 months ± 31.9 months, 16 patients (69.6%) improved, six (26.1%) remained stable, and one (4.3%) had died secondary to multiple traumatic injuries. At long-term follow-up, no patient had a transient ischemic attack or stroke or presented evidence of de novo in-stent stenosis or stent thrombosis. There were no neurologic sequelae after partial or total discontinuation of antiplatelet therapy in seven patients undergoing trauma-related surgeries. CONCLUSIONS: Selected cases of traumatic CAD can be safely managed by endovascular stent-assisted angioplasty. Procedural complications are infrequent; the need for postprocedure antiplatelet therapy is a concern. Early detection is essential to avoid stroke. Stenting restores the integrity of the vessel lumen immediately, efficiently prevents the occurrence or recurrence of ischemic events, and avoids the need of long-term anticoagulation.

Original languageEnglish
Pages (from-to)216-221
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume72
Issue number1
DOIs
StatePublished - 1 Jan 2012
Externally publishedYes

Keywords

  • Anticoagulation
  • Carotid artery
  • Dissection
  • Ischemic stroke
  • Stents
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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