Extracranial traumatic aneurysms due to blunt cerebrovascular injury.
OBJECTIVE
Traumatic aneurysms occur in 10% of extracranial blunt traumatic cerebrovascular injuries (TCVI). The clinical consequences and optimal management of traumatic aneurysms are poorly understood.


METHODS
A prospective study of TCVI at a Level I trauma center identified 7 patients with 19 extracranial traumatic carotid artery or vertebral artery aneurysms. An additional 6 patients with 7 traumatic aneurysms were followed outside of the prospective study, giving a total of 13 patients with 26 traumatic aneurysms. All patients were treated with 325 mg aspirin daily and underwent clinical and imaging follow-up beyond the initial hospitalization. Endovascular treatment was reserved for aneurysms demonstrating significant enlargement on follow-up imaging. Clinical and radiographic features were assessed.


RESULTS
The 7 patients with traumatic aneurysms identified in the prospective cohort comprised 10.3% of all patients with TCVI. Two (15.4%) of the 13 total patients suffered an ischemic stroke in the setting of TCVI with traumatic aneurysm formation. No patient experienced an ischemic stroke or new symptoms after the initiation of antiplatelet therapy. Clinical and radiographic follow-up averaged 15.8 months (range 0.4-41.7 months) and 22.0 months (range 6.6-55.7 months), respectively. Ten (38.5%) of 26 aneurysms were not visualized on last follow-up, 10 (38.5%) were smaller, 1 (3.8%) was unchanged, and 5 (19.2%) were larger. Saccular aneurysms were more likely to enlarge than fusiform aneurysms (33.3% vs 11.8%). Results of a Fisher exact test tend to support the assertion that the 2 different aneurysm morphologies behave differently (p = 0.07). Two saccular aneurysms were treated with stenting.


CONCLUSIONS
The majority of traumatic aneurysms can be managed with an antiplatelet regimen of 325 mg aspirin daily and serial imaging. Saccular aneurysms have a greater tendency to enlarge when compared with fusiform aneurysms.
Division of Neurosurgery, Department of Surgery, and.
Paul M
PM
Foreman
Christoph J
CJ
Griessenauer
Michael
M
Falola
Mark R
MR
Harrigan
D000293:Adolescent; D000328:Adult; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D001241:Aspirin / Q000627:therapeutic use; D002533:Cerebral Angiography; D020214:Cerebrovascular Trauma / Q000150:complications*; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D016489:Head Injuries, Closed / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
CA = carotid artery; CTA = CT angiography; DSA = digital subtraction angiography; ICA = internal carotid artery; TCVI = traumatic cerebrovascular injury; VA = vertebral artery; blunt trauma; carotid artery; dissecting aneurysm; pseudoaneurysm; traumatic aneurysm; traumatic cerebrovascular injury; vascular disorders; vertebral artery