Individualized endovascular treatment of high-grade traumatic vertebral artery injury.
BACKGROUND
Traumatic vertebral artery injury (TVAI) is associated with craniocervical trauma that can lead to potentially fatal posterior circulation stroke. It presents a clinical challenge since it is hard to detect and there are no widely accepted guidelines on diagnosis and management. High-grade TVAI is more difficult to treat and no consensus has been reached yet.


METHODS
We performed a single-center, long-term, therapeutic study involving 272 patients with craniocervical injury, eleven of which were diagnosed with high-grade TVAI. Individualized endovascular treatments were performed on these patients based upon the hemodynamic and morphological characteristics of the injured vertebral artery. Postoperative angiography was conducted at 2 weeks, 3 months and 6 months, and then annually after intervention.


RESULTS
Ten vertebral pseudoaneurysms and one arteriovenous fistula (AVF) were confirmed by postoperative angiography. All the participants' neurological deficit symptoms disappeared or were significantly alleviated gradually, and no new symptoms were found after endovascular treatment. Follow-up angiography of the patients with pseudoaneurysms showed a normally shaped vertebral artery with no stenosis or aneurysms; the angiographic result of the patient with the AVF presented successful embolization in the proximal vertebral artery fistula with no progression or new stenosis. Their modified Rankin Scale (mRS) scores were also satisfactory.


CONCLUSIONS
Application of individualized endovascular therapy in high-grade TVAI is safe, technically feasible and clinically effective, but there is no comparison between endovascular management and other management approaches because randomized trials cannot be carried out currently.
Department of Neurosurgery, Shanghai Changzheng Hospital, the Second Military Medical University, No 415, Fengyang road, Shanghai, China, 200003, meiqiyong@gmail.com.
Qiyong
Q
Mei
Mingxing
M
Sui
Wenze
W
Xiao
Zhengwang
Z
Sun
Rulin
R
Bai
Chengguang
C
Huang
Lijun
L
Hou
D000293:Adolescent; D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000628:therapy*; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D057285:Precision Medicine; D020196:Trauma, Nervous System / Q000175:diagnosis / Q000628:therapy*; D014711:Vertebral Artery / Q000293:injuries*; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000628:therapy