Single-center experience on endovascular reconstruction of traumatic internal carotid artery dissections.
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.
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. jcohenns@yahoo.com
José E
JE
Cohen
John M
JM
Gomori
Eyal
E
Itshayek
Sergey
S
Spektor
Yigal
Y
Shoshan
Guy
G
Rosenthal
Samuel
S
Moscovici
D000293:Adolescent; D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000601:surgery; D020215:Carotid Artery, Internal, Dissection / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult