title: Current trends in endovascular management of traumatic cerebrovascular injury.
abstract: BACKGROUND
  The role of catheter angiography in the diagnosis and management of traumatic cerebrovascular injury has evolved rapidly with advances in CT and MR angiography and continued development of endovascular techniques.
  
  
  OBJECTIVE
  To identify the modern spectrum of traumatic arterial injury encountered during catheter neuroangiography and to examine current patterns of endovascular treatment.
  
  
  METHODS
  Records of trauma patients undergoing catheter neuroangiography over a 4 year period at two high volume centers were retrospectively reviewed. The sample comprised 100 separate arterial lesions that were classified according to mechanism, location, acuity, and endovascular treatment. Follow-up imaging and clinical notes were reviewed to identify procedural complications.
  
  
  RESULTS
  Of 100 arterial lesions, 81% were related to blunt trauma. Distribution of lesions by location was 42% intracranial, 39% cervical, and 19% extracranial. The most common injuries were pseudoaneurysm (38%), fistula (29%), and dissection (19%). In total, 41% of lesions underwent endovascular treatment, with trends favoring treatment of non-acute, penetrating, non-cervical, and high grade lesions. Therapy involved coil embolization for 89% of treated lesions. There were a total of two immediate neurovascular complications and one delayed neurovascular complication; one of these resulted in a permanent neurological deficit.
  
  
  CONCLUSIONS
  Our experience in a large cohort of patients suggests that a relatively high proportion of traumatic arterial lesions identified by catheter angiography are treated by endovascular means, with a low rate of immediate and delayed neurovascular complications.
authors: Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA.
authors: Akash P
authors: AP
authors: Kansagra
authors: Daniel L
authors: DL
authors: Cooke
authors: Joey D
authors: JD
authors: English
authors: Ryan M
authors: RM
authors: Sincic
authors: Matthew R
authors: MR
authors: Amans
authors: Christopher F
authors: CF
authors: Dowd
authors: Van V
authors: VV
authors: Halbach
authors: Randall T
authors: RT
authors: Higashida
authors: Steven W
authors: SW
authors: Hetts
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D002533:Cerebral Angiography / Q000639:trends*; D019468:Disease Management; D057510:Endovascular Procedures / Q000379:methods / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies
keywords: Angiography; Artery; Brain; Neck; Trauma