title: Management of traumatic carotid artery dissection: initial experience of a single center.
abstract: Traumatic carotid artery dissection (tCAD) bears the risk of hypoperfusion inducing delayed cerebral ischemia. The lack of consensus on standard treatment of tCAD remains a great challenge. Here, we present our successes on a series of patients with delayed tCAD diagnosis and treatment using multimodality treatment strategies. We retrospectively reviewed 21 patients with tCAD treated with carotid artery stent placement or anticoagulation therapy. There were 14 dissection locations (66.67 %) which involved extracranial internal carotid artery (ICA) and seven locations (33.33 %) which involved both extracranial and intracranial ICA. Stenosis severity was 70-99 % in 16 cases (76.19 %) and <70 % in 5 cases (23.81 %). Endovascular stents were administrated to 17 patients with hypoperfusion as evaluated by radiological methods, while anticoagulation therapy was administrated to the other four patients. Carotid revascularization was performed with one (9/17 patients) or multiple (8/17 patients) stents. None of the patients experienced a procedure-related complication. At discharge, the mean modified Rankin Scale (mRS) score of patients was 1.08 ± 0.76. Neither additional neurological deficient nor restenosis happened during the follow-up period. More vigilance is required to assure timely diagnosis of patients with delayed tCAD. Assessment of cerebral perfusion is an effective approach in tCAD treatment in our experience.
authors.affiliation: Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197, Rui Jin Er Road, Shanghai, 200025, China.
authors.forename: Xie
authors.initials: X
authors.lastname: Zhengxing
authors.affiliation: Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197, Rui Jin Er Road, Shanghai, 200025, China.
authors.forename: Cui
authors.initials: C
authors.lastname: Zhenwen
authors.affiliation: Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197, Rui Jin Er Road, Shanghai, 200025, China.
authors.forename: Sun
authors.initials: S
authors.lastname: Yuhao
authors.affiliation: Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197, Rui Jin Er Road, Shanghai, 200025, China.
authors.forename: Zhong
authors.initials: Z
authors.lastname: Zhihong
authors.affiliation: Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197, Rui Jin Er Road, Shanghai, 200025, China. rjblg@sina.com.
authors.forename: Bian
authors.initials: B
authors.lastname: Liuguan
authors.affiliation: Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197, Rui Jin Er Road, Shanghai, 200025, China.
authors.forename: Sun
authors.initials: S
authors.lastname: Qingfang
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002545:Brain Ischemia / Q000188:drug therapy / Q000601:surgery; D002340:Carotid Artery Diseases / Q000188:drug therapy / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D002544:Cerebral Infarction; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Endovascular stents; Hypoperfusion; Traumatic carotid artery dissection