title: Stent-assisted arterial reconstruction of traumatic extracranial carotid dissections.
abstract: OBJECTIVE
  Dissection of the internal carotid artery is a well-recognized complication of craniocervical trauma with potentially grave neurological outcome in patients with significant ischemic symptoms. Traditional anticoagulation therapy may not be applicable, since anticoagulation is contraindicated in multiple trauma or penetrating injuries. In these circumstances, rapid stenting followed by antiplatelet therapy may be performed.
  
  
  METHODS
  Patients with angiographically proven traumatic carotid artery dissection were prospectively selected for endovascular stenting according to clinical and radiological criteria. Essentially, patients with hemodynamic significant hemispheric hypoperfusion (as indicated by angiography or perfusion MRI), or in whom anticoagulant therapy failed clinically, or anticoagulation was contraindicated, were considered at high risk for stroke and were selected for stenting. Twelve patients were selected for stenting.
  
  
  RESULTS
  In seven patients, multiple stents were implanted. Endovascular treatment reduced mean dissection stenosis from mean 65+/-33% (range, 10-100%) to mean 7+/-9% (range, 20-0%). In a mean clinical follow-up of 11.5+/-6.3 months (range 3-24 months), eight patients improved and four remained stable, and none of the patients had a TIA or stroke. Doppler U/S studies did not detect any signs of de novo in-stent stenosis in any of the patients at a mean follow-up time of 9.2+/-6.4 months.
  
  
  CONCLUSIONS
  In selected cases of traumatic dissections of the carotid artery, endovascular stent-assisted angioplasty may immediately restore the integrity of the vessel lumen, even of acutely occluded arteries. This approach efficiently prevented the occurrence of new ischemic events, without additional anticoagulation.
authors.affiliation: Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel. jcohenns@yahoo.com
authors.forename: José E
authors.initials: JE
authors.lastname: Cohen
authors.forename: Tamir
authors.initials: T
authors.lastname: Ben-Hur
authors.forename: John M
authors.initials: JM
authors.lastname: Gomori
authors.forename: Felix
authors.initials: F
authors.lastname: Umansky
authors.forename: Pedro
authors.initials: P
authors.lastname: Lylyk
authors.forename: Gustavo
authors.initials: G
authors.lastname: Rajz
mesh_terms: D000293:Adolescent; D000328:Adult; D002339:Carotid Arteries / Q000601:surgery*; D020212:Carotid Artery Injuries / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome