Endovascular stent-assisted angioplasty in the management of traumatic internal carotid artery dissections.
OBJECTIVE
The prognosis of traumatic dissection of the internal carotid artery is worse than for spontaneous dissections. Rapid stenting followed by antiplatelet therapy may prevent complications when anticoagulation therapy is not applicable.


METHODS
Patients with angiographically proven traumatic carotid artery dissection and hemodynamic significant hemispheric hypoperfusion, or in whom anticoagulant therapy was either contraindicated or failed clinically, were regarded as being at high risk for stroke and were selected for stenting.


RESULTS
Ten patients with traumatic dissection underwent stenting. Endovascular treatment reduced mean dissection stenosis from 69% to 8%. During a mean clinical follow-up time of 16 months, none had additional transient ischemic attacks or stroke. Doppler ultrasound studies did not detect any signs of de novo in-stent stenosis.


CONCLUSIONS
In selected cases of traumatic carotid artery dissections, endovascular stent-assisted angioplasty immediately restored the integrity of the vessel lumen and prevented efficiently the occurrence of new ischemic events, without additional anticoagulation.
Cohen
José E
JE
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. jcohenns@yahoo.com
Ben-Hur
Tamir
T
Rajz
Gustavo
G
Umansky
Felix
F
Gomori
John M
JM
D000328:Adult; D000792:Angiography / Q000379:methods; D017130:Angioplasty; D000925:Anticoagulants / Q000494:pharmacology; D001241:Aspirin / Q000494:pharmacology; D001792:Blood Platelets / Q000378:metabolism; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002339:Carotid Arteries / Q000473:pathology*; D002343:Carotid Artery, Internal / Q000473:pathology; D020215:Carotid Artery, Internal, Dissection / Q000601:surgery / Q000628:therapy*; D000077144:Clopidogrel; D003251:Constriction, Pathologic; D004058:Diffusion; D005260:Female; D006801:Humans; D007511:Ischemia; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011379:Prognosis; D015607:Stents; D020521:Stroke / Q000628:therapy; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000494:pharmacology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014947:Wounds and Injuries
D000925:Anticoagulants; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin