Abstract W P53: Extracranial Traumatic Aneurysms Due to Blunt Cerebrovascular Injury

Abstract

Background and Purpose: Traumatic aneurysms occur in about 10% of extracranial blunt traumatic cerebrovascular injuries (TCVI). The clinical consequences and optimal management of traumatic aneurysms are poorly understood. Methods: A prospective systematic study of TCVI at a Level I trauma center identified seven patients with 19 extracranial carotid or vertebral artery aneurysms. An additional six patients with seven traumatic aneurysms were followed outside of the prospective study. All patients were treated with aspirin 325 mg daily and underwent clinical follow up and imaging beyond the initial hospitalization. Endovascular treatment was reserved for aneurysms demonstrating significant enlargement on follow-up imaging. Ischemic complications, aneurysm symptoms, and aneurysm appearance on follow-up CT angiography (CTA) were assessed. Results: The seven patients with traumatic aneurysms identified in the prospective cohort comprised 10.3% of all patients with TCVI. Two patients (15.4%) patients had an ischemic stroke. No patient experienced an ischemic stroke or new symptom following the initiation of antiplatelet therapy. Clinical and radiographic follow-up with CTA averaged 22.0 months (range 6.6-55.7 months). Ten of 26 (38.5%) aneurysms were not visualized on last follow up CTA, 10/26 (38.5%) were smaller, 1/26 (3.8%) were unchanged, and 5/26 (19.2%) were larger. Saccular aneurysms were more likely to enlarge than fusiform aneurysms (33.3 vs 11.8%). Two aneurysms (both > 15 mm in size) were treated with stenting. Conclusion: The majority of traumatic aneurysms can be managed with an antiplatelet regimen of aspirin 325 mg daily and serial imaging. Saccular aneurysms have a greater tendency to grow when compared to fusiform aneurysms.