Long-term graft patency rates and clinical outcomes after revascularization for symptomatic traumatic internal carotid artery dissection.
BACKGROUND
Surgical management of traumatic internal carotid artery (ICA) dissection remains controversial. Therefore, the delayed outcomes and graft patency rates of patients who underwent bypass procedures for symptomatic traumatic ICA dissection were studied.


METHODS
Between September 1989 and August 1996, 13 patients (9 male and 4 female patients; mean age, 30.6 yr) underwent 16 revascularization procedures for symptomatic traumatic ICA dissection. The duration of clinical follow-up averaged 47.3 months (range, 12-94 mo) from the date of diagnosis. The duration of radiographic follow-up (catheter or magnetic resonance angiography, duplex Doppler ultrasonography) averaged 24 months (range, 12-60 mo).


RESULTS
ICA dissection was caused by blunt (n = 11) or penetrating trauma (n = 2). Associated angiographic abnormalities included seven ipsilateral ICA occlusions, six dissecting aneurysms, two carotid-cavernous fistulae, and six contralateral traumatic ICA dissections. Patients requiring early revascularization (n = 6) underwent bypass procedures an average of 19.2 days after their injuries. Medically managed patients who developed ischemia later were revascularized a mean of 7.8 months after injury. The mean Glasgow Coma Scale score at the time of presentation was 10 (range, scores of 6-15), and the mean Glasgow Coma Scale score before revascularization was 14 (range, scores of 9-15). There were 14 saphenous vein ICA bypasses (8 cervical-to-petrous, 3 cervical-to-middle cerebral artery, 3 petrous-to-supraclinoid) and 2 superficial temporal artery-to-middle cerebral artery bypasses. There was one early postoperative graft occlusion, which responded to surgical thrombectomy. One patient with multiple other traumatic injuries died as a result of a pulmonary embolus 12 months after revascularization. All remaining patients had Glasgow Outcome Scale scores of 5, with patent bypass grafts confirmed during follow-up.


CONCLUSIONS
Revascularization for persistently symptomatic traumatic ICA dissection eliminated ischemia and was associated with excellent long-term outcomes and graft patency rates.
Division of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix, USA.
A G
AG
Vishteh
F F
FF
Marciano
C A
CA
David
W I
WI
Schievink
J M
JM
Zabramski
R F
RF
Spetzler
D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000601:surgery*; D020212:Carotid Artery Injuries; D002343:Carotid Artery, Internal / Q000473:pathology / Q000601:surgery; D002548:Cerebral Revascularization; D002648:Child; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation; D017131:Thrombectomy; D016896:Treatment Outcome