Traumatic Dissection Research Articles

Sudden unexpected atraumatic arterial dissection-related death after seizures

BackgroundTo date, it has been assumed that acute seizures which arise in the context of sudden, spontaneous, atraumatic, acute, arterial dissections (SAAADs) are downstream consequences of the dissections driven by syncope or focal brain lesions (FBLs). As this subject has not been formally investigated, likely due to its rarity, we reviewed published case reports (CRs) to examine the veracity of this assumption. MethodsWe included CR describing patients diagnosed with both acute seizures and arterial dissections in order to ascertain the temporal sequence between acute seizures and typical SAAAD symptoms. In addition, we quantified the frequency with which hypotension, bradycardia, and FBLs are associated with acute seizures in such cases. ResultsWe found 45 published CRs, six (13.3%) of which involved traumatic arterial dissections and 39 (86.7%) which involved SAAADs. Of the latter, twenty-one (53.8%) described seizures that followed typical SAAAD symptoms (SAFO), and 18 (46.2%) that preceded all such symptoms (SATO). On average, blood pressure and heart rate for both groups exceeded the normal range. Of the CRs that included magnetic resonance imaging (MRI) scans, 8 (100%) SAFO but only 6 (54.5%) SATO patients demonstrated FBLs (p<0.03). A conspicuously large fraction of SATO patients had known epilepsy compared with SAFO patients, (33.3% vs 4.8%; p<0.02). In addition, SATO epilepsy patients’ seizure semiologies frequently resembled their breakthrough seizures (BTS). The most common SAAAD associated with acute seizures was aortic dissection (AoD; 17/45; 37.8%). Nine CRs (20%) described patients who died soon after presentation, seven of which were associated with AoDs, including one epilepsy patient. Six of these seven AoDs occurred in patients who suffered from chronic hypertension (CHTN). All five deaths in the SATO group followed first ever seizures (FES) [four AoDs and one coronary artery dissection (CoAD)]. ConclusionAcute seizures arising in the context of SAAADs are not necessarily associated with hypotension or FBLs, and frequently appear to precede the associated dissections. These results suggest that seizures could act as triggers for SAAADs. In addition, sudden unexpected atraumatic acute arterial dissection-related death after seizure (SUADAS) might be a distinct cause of sudden death in epilepsy patients.

Multiple Traumatic Fat Embolism with Aortic Dissection III A Case Report

Multiple trauma refers to the severe injury of multiple body parts caused by a single injury factor, occurring simultaneously or consecutively. This condition leads to numerous tissue injuries, significant organ damage, and high mortality rates. Fat embolism syndrome, on the other hand, is a clinical condition marked by the presence of fat droplets in the bloodstream, resulting in a range of symptoms and signs. The most prevalent manifestations include ecchymotic rash, respiratory distress, and neurological dysfunction. In intensive care units (ICUs), routine CT scans are essential, particularly chest CTs, which often reveal a diffuse distribution of ground glass opacity shadows. In more extensive cases, “snowstorm”-like changes may be observed. Traumatic aortic injuries frequently manifest as scissor force injuries at the aortic isthmus, with the majority of cases occurring in this region. However, other aortic injuries typically occur at the aortic hiatus and the origins of major vessels. Instances where both fat embolism and traumatic aortic dissection III occur concurrently due to multiple trauma are exceptionally rare.

Combined treatment of wounded with traumatic aneurysm of posterior communicating artery complicated by intraventricular hemorrhage

Cerebral blood vessel trauma (CBVT) is a serious condition of craniocerebral injury. According to literature data, different varieties of CBVT in penetrating gunshot craniocerebral injuries are found in 30–45 % of cases. Traumatic pseudoaneurysms are the most common finding in late evaluation and can lead to life-threatening episodes of intracranial hemorrhage.In addition, CBVT includestraumatic occlusion, dissection of vessels, rupture of cerebral arteries, formation of arteriovenous fistulas (carotid-cavernous anastomoses), venous stasis, etc. Injured persons with traumatic dissection and injury of vertebrobasilar pool have the highest risks of lethal outcome. There are no largerandomised trials and national recommendations for the treatment of CBVT, individual observations and small series of clinical cases have been published. In this connection, there is a need for a detailed analysis of all clinical cases, the development of tactics for early diagnosis and an algorithm for the treatment of wounded with CBVT.The article presents a review of the literature data that characterizes the current understanding of CBVT, and a clinical case of traumatic occlusion of the middle cerebral artery and pseudoaneurysm of the posterior communicating artery in a wounded man with a gunshot penetrating cranioorbital wound, who was treated at the neurosurgical center of the N.N. Burdenko Main Military Clinical Hospital.In the early period after the injury, the patient underwent endovasal occlusion of a traumatic aneurysm of the posterior connective artery by microspirals followed by local thrombolysis of intraventricular hematomas through a ventricular catheter. The catamnesis was 150 days, the score on the modified Rankin scale was 3, the Glasgow outcome scale extended was 5.

Posttraumatic Ischemic Stroke Secondary to Traumatic Internal Carotid Artery Dissection: A Case Report

Posttraumatic Ischemic Stroke Secondary to Traumatic Internal Carotid Artery Dissection: A Case Report

Are There Differences between Traumatic and Spontaneous Cervical Artery Dissections?

(1) Background: Cervical arterial dissections (CeAD) are a common cause of stroke in young adults. CeAD can be spontaneous (sCeAD) or traumatic (tCeAD). Whether CeAD subtypes differ in clinical, radiological, and outcome characteristics remains unexplored. (2) Methods: Patients with CeAD were identified and divided between sCeAD and tCeAD. Demographics, clinical features, risk factors, imaging findings, treatments, and outcomes were compared between the groups. Logistic regressions were used to determine characteristics associated with favorable outcome. (3) Results: Overall, 154 patients were included (106 sCeAD and 48 tCeAD). Patients with sCeAD were significantly older (mean ± SD 46 ± 12 vs. 35 ± 14, p < 0.001) and were more likely to have hyperlipidemia (19% vs. 4%, p = 0.016), but other risk factors did not differ. Patients with tCeAD less often had signs of early infarction on imaging (21% vs. 49%, p = 0.001) and had lower stroke severity on admission (NIHSS, median, interquartile range [IQR] 0 (0-9) vs. 2 (0-4), p = 0.012), but more often had symptomatic intracranial hemorrhages (12.5% vs. 2%, p = 0.006). Patients with tCeAD less often had favorable outcomes at 90 days (78% vs. 97%, p < 0.001). In the regression analysis, the only variables associated with favorable outcome were age (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.03-1.24), initial stroke severity (OR 0.84, 95% CI 0.73-0.97), degree of vessel stenosis (OR 0.35, 95% CI 0.14-0.83), and involvement of multiple vessels on presentation (OR 0.04, 95% CI 0.02-0.70), whereas dissection subtype was not associated (OR 0.45, 95% CI 0.03-68.80). (4) Conclusions: Dissection subtype is not an independent modifier of the chances of attaining functional independence.

Surgical treatment of one traumatic carotid artery dissection: A case report and review of the literature.

Dissection of the cervical arteries is the most commonly identified cause of stroke in young patients. This report helps to investigate the etiology, diagnosis, and treatment of cervical artery dissection (CAD). A 40-year-old female presented with a 3-week history of right carotid artery dissection due to a fall. The patient was admitted to the local hospital 3 weeks ago with a right neck impingement after a fall, and presented with right neck pain. The local hospital CT scan showed a dissection of the middle segment of the right common carotid artery. The patient clinical manifestations and imaging tests confirmed that right carotid artery dissection. Medical treatment with antiplatelet failed, and the CT scan showed progression of dissection. Carotid endarterectomy (CEA) was performed, and the prognosis is good. This patient was followed up at 1 and 6 months after the operation, CT scan showed the original stenotic vessels returned to standard diameter. Diagnosis of CAD mainly depends on clinical manifestations and imaging. we recommend that clinicians can prescribe either anticoagulants or antiplatelet therapy. CAD can be effectively treated by surgical reconstruction, if medical treatment with anticoagulation or antiplatelet fails or if carotid aneurysms and/or high-grade carotid stenosis persisted or have newly developed.

The Silent Threat: Unraveling the Rare Catastrophic Complication after Elective Cranioplasty

AbstractAlthough cranioplasty seems to be a simple procedure, fatal complication of development of diffuse severe cerebral edema following cranioplasty although unusual have been reported in a few cases. The mechanism for this occurrence is still speculative. A 38-year-old male patient presented with a history of having undergone left decompressive hemicraniectomy following a road traffic accident with traumatic left intracranial internal carotid artery dissection leading to anterior cerebral artery and middle cerebral artery territory infarct and endovascular embolization of traumatic type 1 left caroticocavernous fistula. The preoperative computed tomography scan of the brain revealed left frontotemperoparietal craniectomy defect with sunken flap and diffuse encephalomalacia with gliosis of the entire left cerebral hemisphere. Immediately following an uneventful cranioplasty surgery with titanium mesh, the patient developed severe hypotension and dilated fixed pupils. Postoperative imaging revealed diffuse severe cerebral edema in bilateral hemispheres with a significant midline shift toward the ipsilateral (left) side, that is, toward the side of cranioplasty. The patient immediately underwent removal of the titanium mesh, and despite all efforts, the patient had a fatal outcome on postoperative day 5. Although this type of fatal complication of diffuse severe cerebral edema is rare in postcranioplasty patients, neurosurgeons must be aware of this complication and close monitoring postprocedure is important, especially in patients with a large craniectomy defect and sunken skin flap.

Traumatic carotid artery dissection in polytrauma: is conservative treatment an adequate strategy? A case report

We present the case of a 24-year-old man, involved in a car accident, with a traumatic right carotid artery dissection Grade II Blunt CerebroVascular Injury (BCVI) according to the Eastern Association for the Surgery of Trauma (EAST). The patient arrived at our hospital without neurological symptoms and was then admitted to the Intensive Care Unit (ICU) for neurological monitoring; antithrombotic and antiplatelet therapy was initiated and in line with current literature, no routine endovascular treatment was performed. Twenty-four hours post-trauma, the patient required an urgent abdominal surgical intervention under general anesthesia. Upon awakening, he presented with left hemiplegia. The CT scan revealed hypodensity in the front-insular region prompting an urgent endovascular procedure. Fourteen days post trauma the patient was discharged from the Stroke Unit with an unchanged neurological performance, despite receiving appropriate treatment for Grade II BCVI, as recommended in current literature. Our patient developed a severe neurological disability. Further discussions are needed.

Aortic Endarterectomy for Traumatic Aortic Dissection

Aortic Endarterectomy for Traumatic Aortic Dissection

Images in Vascular Medicine: Cerebral infarction secondary to traumatic external carotid artery dissection.

Images in Vascular Medicine: Cerebral infarction secondary to traumatic external carotid artery dissection.

DISCONTINUING DAPT: NOT JUST A MATTER OF SCORES BUT OF INTEGRATED EVALUATION? A KEY ROLE OF IMAGING IN A COMPLEX SCENARIO

Abstract The duration of the dual antiplatelet therapy (DAPT) is a widely debated topic within the scientific community. The latest guidelines on acute coronary syndromes have supported the possibility of different therapeutic approaches tailored to patient characteristics. However, the clinical cardiologist‘s decisions are not always based on certain principles. The following case report is a practical example. Discussion: A 31–years–old man came to our attention after a resuscitated cardiac arrest due to ventricular fibrillation during a motorcycle race. His history was characterized by a previous acute myocardial infarction at the age of thirteen due to a traumatic dissection of the proximal left anterior descending (LAD) coronary artery and ascending aorta treated conservatively, with residual transmural necrosis of the mid and subendocardial anterior wall on cardiac MRI. At the admission, ECG showed ST–segment elevation in the anterior leads. Coronary angiography revealed occlusion of the proximal LAD coronary artery, treated with drug–eluting stent (ONYX 5.0 mm), with evidence of dissection and aneurysmal wall of that segment. The patient started a DAPT with aspirin and prasugrel. At discharge, echocardiogram evidenced a moderate left ventricular dysfunction (ejection fraction 34%) with signs of anterior and apical necrosis. Later, the patient was admitted for a subcutaneous defibrillator implantation, due to persistent moderate ventricular dysfunction. One year after revascularization, a lifelong DAPT strategy with downgrading to clopidogrel was considered the best choice for the following considerations: the young age of the patient, the low bleeding risk (PRECISE DAPT score 8), a not elevated DAPT score (value 2), the revascularization in the aneurysmal segment without an appropriate stent apposition (due to absence of a right sizing) and the previous dissection with sign of partial thrombosis at coronary CT. Conclusions: The anatomical complexity of angioplasty procedures and the delicate balance between ischemic and thrombotic risks have led to continuously evolving therapeutic strategies. The clinical scores currently available cannot often account for complex coronary anatomy. Thus, it‘s essential to consider a personalized approach, individualized on clinical and imaging characteristics, that encompasses ischemic and bleeding risk and procedural data for the appropriate treatment for each patient.

Long-term results of etiology-based thoracic endovascular aortic repair: a single-center experience

The use of thoracic endovascular aortic repair (TEVAR) for thoracic aortic aneurysm (TAA) and Stanford type B aortic dissection (TBAD) has been increasing; however, in terms of etiology, the differences of long term after TEVAR outcomes remain unexplored. Thus, we investigated etiology-specific long-term results of TEVAR for TAA and TBAD. A total of 421 TEVAR procedures were performed at our institution from July 2007 to December 2021; 249 TAA cases and 172 TBAD cases were included. Traumatic aortic dissection and aortic injury cases were excluded. The mean observation duration was 5.7 years. The overall 30-day mortality rate was 1.4% (n = 6), with 1.2% (n = 3) in the TAA group and 1.7% (n = 3) in the TBAD group. The overall incidence of postoperative stroke was 0.9% (n = 4), with 1.2% (n = 3) and 0.6% (n = 1) in the TAA and TBAD groups, respectively (p = 0.90). Paraplegia developed in 1.7% (n = 7) of patients, with 2.4% (n = 6) in the TAA group and 0.6% (n = 1) in the TBAD group. Freedom from aortic-related death was not significantly different between the two etiologies; however, thoracic reintervention was more common in the TBAD group (p = 0.003), with endoleak being the most common indication for reintervention. Additionally, retrograde type A aortic dissection occurred in four TBAD cases, while migration occurred in three TAA cases. The perioperative results of TEVAR for TAA and TBAD were satisfactory. The long-term results were unfavorable owing to the occurrence of etiology-specific and common complications. In terms of the high frequency of reintervention, the long-term complications associated with TEVAR are etiology specific.

Traumatic Vertebral Artery Dissection from Repetitive and Prolonged Use of a Handheld Massage Gun (P7-5.029)

Traumatic Vertebral Artery Dissection from Repetitive and Prolonged Use of a Handheld Massage Gun (P7-5.029)

Successfully Procedure Endovascular Carotid Angioplasty Stent in a Case of Neck Stab Wound with Pseudoaneurysm, Recurrent Transient Ischemic Attack, and Horner Syndrome: A Case Report

Highlight: Uncommon Presentation and Diagnosis: The case report presents a unique and rare clinical scenario involving a 14-year-old boy who sustained a neck stab wound, leading to the development of a pseudoaneurysm within the common carotid artery. Multidisciplinary Approach to Treatment: The case highlights the complexity of managing such casesm where a multidisciplinary approach is paramount. The manuscript underscores the significance of involving neurology, interventional neurology, and vascular surgery teams to provide comprehensive and tailored patient care Efficacy of Endovascular Intervention: The successful outcome of the endovascular carotid angioplasty stent procedure highlights its effectiveness as a treatment option for addresing complex vascular conditions like pseudoaneurysm or dissection of the carotid artery. ABSTRACT Introduction: Neck stab wounds can lead to various vascular complications, including pseudoaneurysm or carotid artery dissection. Proper diagnosis and management can prevent recurrent strokes. Case: We reported a case of a 14-year-old boy with a previous left neck stab wound who developed recurrent transient ischemic attacks (TIAs) accompanied by Horner's syndrome and headache following a traumatic common carotid artery dissection. An angiographic examination revealed a pseudoaneurysm or dissection of the left common carotid artery. The patient was initially treated with oral anticoagulant therapy, but he continued to experience recurrent TIA. The patient was then treated endovascularly with a carotid angioplasty stent to restore the compromised carotid artery. Following the endovascular procedure, the patient experienced no complications, showed improvement in Horner syndrome, and had no headache. During the follow-up period, the patient had no more TIAs. Conclusion: Endovascular carotid angioplasty stents are an effective and safe way to treat pseudoaneurysm or dissection of the carotid artery, especially in cases presenting with recurrent TIAs and Horner syndrome. The observed clinical improvement following the procedure indicates significant benefits in enhancing the patient's quality of life and preventing complications from recurrent TIA episodes.

Isolated celiac artery injury: Brief report, review of literature, and suggested grading guidelines

Blunt traumatic dissection of the celiac artery without aortic dissection is a rare event. There is paucity of data on the appropriate management of such injuries. In this brief report, we present a patient with isolated celiac artery dissection after blunt abdominal trauma. The patient was managed non-operatively with anticoagulation and developed splenic infarct. Due to its rarity, no grading criteria and management guidelines exist for the spectrum of isolated blunt CA injuries. Furthermore, it remains unlikely that injury volume will increase to create robust management guidelines. We therefore suggest that isolated celiac artery injury be graded based on the Biffl grading criteria for blunt cerebrovascular injury and managed accordingly.

Placement of Endovascular Stent for Reperfusion of Cerebral Infarct After Pediatric Traumatic Internal Carotid Artery Dissection

Placement of Endovascular Stent for Reperfusion of Cerebral Infarct After Pediatric Traumatic Internal Carotid Artery Dissection

Traumatic vertebral artery dissection causing basilar artery occlusion

Az arteria (a.) basilaris akut elzáródása agytörzsi és kisagyi lágyulást okozhat, mely fatális lehet. Fiataloknál az egyik leggyakoribb oka az a. vertebralis dissectio. Esetismertetésünkben egy 23 éves nőbetegnél egy közúti balesetet követő 4. napon a. vertebralis dissectio következtében elzáródott az a. basilaris, ami súlyos neurológiai állapotot és corticalis vakságot idézett elő. A komputertomográfiás angiográfia az a. basilaris teljes elzáródását és a jobb a. vertebralis hármas–négyes szegmentumában dissectiót igazolt. A koponya-MR-vizsgálat mindkét látókéreg teljes lágyulását igazolta. Mindig gondolnunk kell az a. vertebralis dissectióra politraumatizált betegeknél, illetve ha a fej-nyaki régió torziós vagy ostorcsapásszerű flexiós-extenziós hirtelen mozdulatot végez. Az extracranialis ér dissectiója akár koponya- és nyaki gerinctörés vagy sérülés nélkül kialakulhat. Ha basilaris érocclusiót észlelünk, mindig keresni kell az a. vertebralis dissectio radiológiai jeleit. Orv Hetil. 2023; 164(51): 2033–2038.

Traumatic Aortic Dissection as a Unique Clinical Entity: A Single-Center Retrospective Study.

This study aimed to compare the clinical characteristics, treatment approaches, and outcomes of the Stanford Type B traumatic aortic dissection (TAD) with non-traumatic aortic dissection (NTAD), and assess better management for TAD. We retrospectively analyzed patients who underwent thoracic endovascular aortic repair for Stanford type B aortic dissection at The First Hospital of China Medical University between 2014 and 2022. The patients were divided into TAD and NTAD groups based on whether they had a history of acute trauma. This study ultimately included 65 patients with TAD and 288 with NTAD. We assessed and compared the baseline characteristics, laboratory indicators, imaging features, surgical procedures, and follow-up results between the groups. The TAD group was younger compared to the NTAD group (50.00 [IQR40.00-59.00] vs. 55.00 [IQR 47.00-61.00] years, p = 0.020). A lower percentage of the TAD group had a history of hypertension (20% vs. 71.18%, p < 0.001). The length of aortic dissection was shorter in the TAD group compared to the NTAD group (30.00 [IQR 22.00-40.00] vs. 344.00 [IQR 237.25-400.00] mm, p < 0.001). All patients with TAD underwent TEVAR following the same strategy as NTAD. The mean preoperative duration was 7.00 (IQR 2.00-14.00) days in the TAD group and 11.00 (IQR 8.00-15.00) days in the NTAD group (p < 0.001). TAD showed fewer complications after TEVAR in mid-to-long-term follow-up. TAD is distinct from NTAD. TAD typically presents with more localized lesions than NTAD, and the patients experience a shorter preoperative duration and a better mid-to-long-term outcome.

Traumatic Aortic Dissection Management with Stent Graft Placement

Traumatic Aortic Dissection Management with Stent Graft Placement

Cerebellar Infarction from a Vertebral Artery Dissection after Blunt Chest Injury: A Case Report.

Traumatic vertebral artery dissections resulting in stroke are relatively rare occurrences, especially in the absence of classic physical examination findings. We present the case of a 30-year-old male with chest pain following a car axle falling onto his chest while trying to change a tire. He was discharged from the emergency department after having a negative workup for thoracic injury. Six hours later, the patient returned with headache and was found to have a cerebellar stroke secondary to vertebral artery dissection. After hospitalization, the patient was discharged home without any neurological deficits. As they are usually asymptomatic, up to 80% of patients with blunt cerebrovascular injury will have delayed or missed diagnoses. Given the increased awareness of vascular injuries and their high morbidity, physicians should maintain a high index of suspicion for this diagnosis.