Abstract 100: Endovascular treatment of a traumatic near‐miss vessel injury

Abstract

Introduction Traumatic injuries are a common cause of death, representing nearly 8% of all deaths worldwide(1). Vascular injury can occur in about 3% to 20% of the patients that suffer from a blunt or penetrating craniocervical injury (2). The most commonly injured arteries from penetrating trauma include CCA, ICA, and ECA (73%,22%, and 5% respectively)(3). Embolization is now a well‐established endovascular technique to treat traumatic hemorrhagic injuries(4). We present a case of a patient with a near‐miss injury treated endovascularly. Methods We present the case of a 29‐year‐old male who was found unconscious with a knife embedded in his left face. On arrival at the hospital, the patient was hemodynamically stable with no ongoing hemorrhage or respiratory distress. CTA did not reveal any vascular injury; however, due to the knife's location, the neurointerventional radiology team was consulted and performed an embolization of the proximal third of the internal maxillary artery. The patient was later taken to the operating room for the removal of the knife. Results The non‐serrated end of the knife had resulted in impingement of the distal left ECA just proximal to the bifurcation of the superficial temporal artery and internal maxillary artery and resulting in approximately 80% narrowing of the vessel. Given the extent of impingement of the foreign object on the distal portion of the left ECA, after discussing with the otolaryngology team, a decision was made to proceed with coil embolization of the vessel due to concerns for vessel injury which can result in life‐threatening hemorrhage or pseudoaneurysm during removal of the foreign object in the OR. A total of 4 HydroFrame coils were deployed from the proximal one‐third of the internal maxillary artery into the ECA covering the superficial temporal artery to the origin of the occipital artery. 2 MicroPlex 5mm x 22cm Cosmos 10 bare platinum coils were placed intact to the left ECA extending proximally just distal to the occipital artery. Final AP projection of the left ECA post coil embolization was performed showing complete occlusion of the vessel across the area of impingement at the distal ECA proper. Retrograde filling of the internal maxillary artery was noted. The left middle meningeal artery is occluded and no longer visualized as its origin is being covered by coils. Patient underwent foreign object removal by ENT and had a good functional outcome. Conclusion Endovascular intervention prior to foreign object removal can improve outcomes and decrease the risk of severe vascular injury.