Traumatic Internal Carotid Artery Research Articles

Postimplantation Syndrome after Traumatic Internal Carotid Artery Pseudoaneurysm Repair with Stent

AbstractEndovascular repair of traumatic internal carotid artery pseudoaneurysm (TICAP) with covered stents represents a safe treatment with few complications. However, the presence of foreign material used to treat TICAP and blood clots in the excluded pseudoaneurysms can trigger an acute systemic inflammatory response syndrome called postimplantation syndrome (PIS). To the best of our knowledge, PIS is described only after abdominal aortic endovascular aneurysm repair. Here, we report the case of PIS in a young, healthy, polytraumatized female patient with TICAP treated with endovascular covered stent.

Stenting for Traumatic Pseudoaneurysms of the Cervical Internal Carotid Artery: Case Report and Systematic Review

The optimal stenting approach for traumatic pseudoaneurysms (PSA) of the extracranial internal carotid artery (ICA) remains underinvestigated. We present a case of a traumatic pseudoaneurysm of the extracranial ICA managed with stenting and review of prior published similar cases. The systematic review followed PRISMA-S guidelines and included studies that investigated traumatic pseudoaneurysms of the extracranial ICA managed by stent placement. Statistical analysis assessed the association between the type of injury and stent type, dual antiplatelet therapy (DAPT) duration, and clinical presentation, and the association between stent type and DAPT duration. Our search yielded 82 publications with 135 patients with extracranial ICA PSA treated with stenting. The odds of neck hematoma presentation was 12.2 times greater for patients with penetrating rather than blunt injuries (P= 0.000002). Covered stents had 2.02 times higher odds of use for penetrating rather than blunt injuries compared to bare metal stents. (P= 0.0029). Shorter duration DAPT was seen with bare metal stents having 1.25 higher odds of DAPT duration less than one month compared to covered (P= 0.001). In traumatic extracranial ICA pseudoaneurysms, covered stents are used more commonly for penetrating injuries compared to blunt injuries. Penetrating injuries are more strongly associated with the presentation of a hematoma compared to blunt injuries. Stent type may influence the recommended DAPT duration. Surgeons should consider these findings when selecting stent type and DAPT duration with patients presenting with traumatic extracranial ICA pseudoaneurysm.

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

Quiescent Bilateral Internal Carotid Artery Dissection Following Strangulation

Bilateral internal carotid artery dissection is uncommon and suicide attempts by hanging represent a potential mechanism of direct vascular trauma. Previous reports have documented similar events and awareness is important as internal carotid artery dissection is an extensively recognized cause of acute cerebrovascular events. Our case is of a patient presenting with symptoms suggestive of an acute stroke. Significantly, there was a past medical history of an attempted suicide by hanging 4 years before this admission. Imaging demonstrated bilateral internal carotid artery dissection, an acute ischemic infarct and an incidental well-established infarct. Further investigations to assess an underlying aetiology of the bilateral internal carotid artery dissection were unsuccessful in identifying a secondary cause. Acute intracranial episodes related to traumatic internal carotid artery dissection following suicide attempts by hanging have previously been documented. However, such reports have frequently been temporally related to the period of trauma with patients developing neurological symptoms within a short timeframe after the hanging attempt. We hypothesize a delayed manifestation of underlying vascular damage caused by the inciting neck trauma by prior hanging attempt. The potential for internal carotid artery dissection and vascular distortion secondary to attempted hanging are suggestive of a high-risk cohort, and consideration of selective vascular imaging investigations of this group may be useful in acute stroke prevention.

Traumatic Internal Carotid Artery Aneurysm with a Concomitant Carotid Cavernous Fistula

Post-traumatic sphenoid sinus pseudoaneurysm arising from the cavernous segment of the internal carotidartery (ICA) is rare, and even rarer occurrence is an associated carotid-cavernous fistula (CCF). Here we presentthe case of a young male patient presenting with intractable epistaxis due to a post-traumatic sphenoid sinuspseudoaneurysm of the internal carotid artery and a simultaneous carotid-cavernous fistula.
 How to cite this: Ibrahim MI, Nisar T, Tanveer A, Suhail S, Khan R, Ahmed. Traumatic Internal Carotid Artery Aneurysm with a Concomitant Carotid Cavernous Fistula. Life and Science. 2022; 3(4): 200-202. doi: http://doi.org/10.37185/LnS.1.1.252

Treatment of Traumatic Internal Carotid Artery Aneurysm by Flow-Diverter: A Single-Center Experience

AimTraumatic intracranial aneurysm (TICA) is a rare vascular lesion with various etiologies and a high mortality rate when diagnosed late. In this study, we present our cases of TICA, which we treated with flow-diverter stents due to different etiological factors. MethodsClinical data were recorded for 8 patients: age, gender, etiological factors, aneurysm location, aneurysm type, rupture, main artery status, and postoperative complications. Results75% (n:6) of the patients were male and 25% (n:2) female. Etiologically, there was intracranial tumor surgery in 3 cases (37.5%), fall from height in 2 (25%), road accident in 2 (25%), and blunt trauma in 1 (12.5%). Reconstruction used a flow-diverting stent in all cases. One patient experienced intraoperative iatrogenic rupture of the distal arterioles due to a microwire. Mean angiographic follow-up was 17.8 months (range, 6-32 months). During follow-up, none of the patients required renewed endovascular treatment. ConclusionTraumatic aneurysm is a vascular lesion with high mortality when diagnosed late. In case of suspected vascular injury after trauma or intracranial surgery, further evaluation should be performed without delay. TICA can be safely treated with flow-diverter stents, conserving the main artery.

Traumatic cavernous internal carotid artery pseudoaneurysm presenting with massive epistaxis-a morbid clinical entity

<p>Epistaxis is commonly encountered by clinicians in emergency department. However, severe and recurrent epistaxis is very uncommon especially that arise from the cavernous internal carotid artery (ICA) pseudoaneurysm. Traumatic cavernous internal carotid pseudoaneurysm is a rare cause of the epistaxis but is a fatal and life-threatening clinical condition if left untreated. Massive epistaxis following head injury should alert the clinician to rule out traumatic cavernous ICA pseudoaneurysm. Traumatic pseudoaneurysm of the cavernous part of the ICA is a challenging clinical entity both in diagnosis and treatment. This clinical diagnosis may be suspected in case of patient with history of head injury, massive recurrent epistaxis and delayed onset of blindness. Massive epistaxis after head trauma should alert the clinician for possible cavernous ICA pseudoaneurysm. Carotid angiography confirms the site of pseudoaneurysm. The treatment options are endovascular stent and coil embolization, arterial balloon occlusion and surgical trapping. Timely diagnosis and treatment of this condition give a favorable outcome. In this review article, we discuss the epidemiology, etiopathology, clinical presentations, investigations and current treatment of the traumatic cavernous ICA pseudoaneurysm.</p>

Cerebral infarct secondary to traumatic internal carotid artery dissection.

BACKGROUNDTraumatic internal carotid artery dissection (TICAD) is rare and can result in severe neurological disability and even death. No consensus regarding its diagnostic screening and management has been established.AIMTo investigate the clinical presentation, imaging features, diagnostic workup, and treatment of TICAD.METHODSIn this retrospective case series, emergency admissions for TICAD due to closed head injury were analyzed. The demographic, clinical, and radiographic data were retrieved from patient charts and the picture archiving and communication system.RESULTSSix patients (five males and one female, age range of 43-62 years, mean age of 52.67 years) presented with TICAD. Traffic accidents (4/6) were the most frequent cause of TICAD. The clinical presentation was always related to brain hypoperfusion. Imaging examination revealed dissection of the affected artery and corresponding brain infarction. All the patients were definitively diagnosed with TICAD. One patient was treated conservatively, one patient underwent anticoagulant therapy, two patients were given both antiplatelet and anticoagulant drugs, and two patients underwent decompressive craniectomy. One patient fully recovered, while three patients were disabled at follow-up. Two patients died of refractory brain infarction.CONCLUSIONTICAD can cause catastrophic outcomes and even refractory brain hernia. Early and efficient diagnosis of TICAD is essential for initiating appropriate treatment. The treatment of TICAD is challenging and variable and is based on clinician discretion on a case-by-case basis.

A Case of Traumatic Internal Carotid Artery Pseudoaneurysm Diagnosed by Massive Bleeding During Endoscopic Sinus Surgery

A Case of Traumatic Internal Carotid Artery Pseudoaneurysm Diagnosed by Massive Bleeding During Endoscopic Sinus Surgery

Penetran Travmaya Bağlı İnternal Karotis Arter Diseksiyonu ile İlişkili İskemik İnme Olgusu: Nedensellik Bağı İçin Adli Tıbbi Değerlendirme

İskemik inme, önemli bir morbidite ve mortalite nedenidir. Ancak travmatik internal karotis arter diseksiyonuna bağlı iskemik inme nadir görülen bir durumdur.
 Bu olgu sunumunda, 35 yaşında erkek hasta boynundan kesici-delici alet ile yaralanmış ve hastada total afazi ve sağ hemiparezi meydana gelmişti. Radyolojik incelemelerde sol parieto-temporal bölgede beyin enfarktüsü ve bıçaklama sonrası internal karotis arter diseksiyonu tanısı konuldu.
 Bu olgunun adli tıp anabilim dalında yapılan adli tıbbi değerlendirmesinde, başka travmatik veya patolojik bir durumun varlığını dışlamak ve “kesici-delici alet yaralanmasına bağlı internal karotis arter yaralanması” ile “iskeminin neden olduğu inme ve afazi” arasında nedensellik bağı kurulması için nöroşirürji anabilim dalı ile işbirliği yapıldı.
 Bu makalede sunulan olgu nedeniyle literatür gözden geçirilmiş, adli tıp uygulamalarında nedensellik kavramı ve prosedürü ele alınmış ve bu gibi durumlarda multidisipliner yaklaşımın önemini vurgulanmıştır.

Efficacy and Safety of Willis Covered Stent for Treatment of Complex Vascular Diseases of the Internal Carotid Artery

Willis covered stents are used in clinical practice for some complex cerebrovascular diseases. However, the performance of the Willis covered stent requires further investigation. In this study, we investigate the safety and efficacy of Willis covered stents for the treatment of complex vascular diseases of the internal carotid artery (ICA). Thirteen patients with complex ICA diseases treated with the Willis covered stent system at our institution from October 2016 to January 2018 were analyzed retrospectively. Follow-up observation and digital subtraction angiography (DSA) examination were conducted at about 6-10months after the treatment. The complex vascular diseases of the ICA were successfully treated in 12 patients. The technical success rate was 92.3%. Pathologically, 13 lesions included blood blister-like aneurysm (n=7), traumatic pseudoaneurysm (n=1), traumatic carotid artery rupture (n=1), and aneurysm with arteriovenous fistula (n=4). Thirteen patients with complex vascular diseases of the ICA were treated with 15 Willis covered stents. The release sites of Willis covered stents were the C7 (n=2), C6 (n=1), C5 and/or C4 (n=9), and the C2 (n=3) segment of the ICA. DSA performed immediately after stent deployment revealed that complete occlusion of the lesion was achieved in 11 patients and endoleak was observed in 2 patients. Of the 11 patients, postoperative DSA examination indicated that the lesions were occluded completely. Among 2 patients, who had a second stent implantation at the break of the ICA, the traumatic ICA rupture was essentially completely obstructed in 1 patient. The endoleak remained in 1 patient with carotid cavernous sinus fistula because the placement of the second stent system was difficult with his ICA tortuosity. No recurrence of aneurysms, hemorrhagia, and other lesions was observed, and the patients' parent arteries were patent without stenosis. No procedure-related complications or deaths occurred during follow-up. For the treatment of complex vascular diseases in the ICA, Willis covered stent implantation is safe and effective. However, longer follow-up, large-sample controlled studies, and multicenter studies are needed for further confirmation.

Endovascular reconstruction of extracranial traumatic internal carotid artery dissections: a systematic review.

Extracranial internal carotid artery dissection (ICAD) is a potential source of morbidity and mortality in trauma patients and requires high degree of suspicion for diagnosis after the initial presentation. Occasionally, if standard therapy is contraindicated, endovascular reconstruction is a treatment option. The aim of this systematic review was to report clinical and radiographic outcomes following endovascular repair of ICAD of traumatic and iatrogenic etiology. A comprehensive systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed and Cochrane Library databases were searched. Twenty-four studies comprising 191 patients (204 lesions) were included; 179 underwent traditional carotid artery stenting (CAS), whereas 12 patients underwent flow diversion with the pipeline embolization device (PED). In total, 75.7% of the CAS group and 66.6% of the PED group presented with ICAD-related symptomatology. Concomitant pseudoaneurysms were identified in 61.9% and 78.5% of lesions in the CAS and PED group, respectively. Adverse event rates among CAS-treated lesions after 30-day follow-up were below 2.2% for stroke, transient ischemic attack, and mortality. During follow-up in the CAS group, there was no incidence of ICAD-related stroke or death and 2.2% of patients underwent a repeat CAS procedure. In the PED group, no patient suffered stroke or death in the reported follow-up. In the PED cohort, there was an adequate occlusion rate and no patient had to be retreated. Endovascular reconstruction of traumatic or iatrogenic ICAD appears safe. This approach demonstrated acceptable short- and long-term clinical and radiographic outcomes in both groups.

A 49-year-old Woman of a Massive Cerebral Hemorrhage After Carotid Artery Stenting for Traumatic Internal Carotid Artery Stenosis due to an Elongated Styloid Process

A 49-year-old Woman of a Massive Cerebral Hemorrhage After Carotid Artery Stenting for Traumatic Internal Carotid Artery Stenosis due to an Elongated Styloid Process

Surpass Streamline Flow-Diverter Embolization Device for Treatment of Iatrogenic and Traumatic Internal Carotid Artery Injuries.

Iatrogenic and traumatic cerebral internal carotid artery injuries are uncommon but potentially lethal complications. Direct surgical repair of ICA injuries may be difficult in an acute setting. However, endovascular treatment with a flow-diverter embolization device is a feasible alternative technique that we experienced. In this clinical report, we describe demographic data, radiographic images, lesion characteristics, endovascular procedure notes, postprocedural hospital course, and follow-up digital subtraction angiography of 5 patients. At least 6-month follow-up was available in all patients without occurrence of rebleeding and other complications.

Anchoring Pipeline Flow Diverter Construct in the Treatment of Traumatic Distal Cervical Carotid Artery Injury

Background: Traumatic extracranial internal carotid artery (ICA) dissections are uncommon and can be difficult to treat. Thinning of adventitia and dilatation may occur following arterial dissection, thus resulting in a fusiform pseudoaneurysm, which can subsequently cause bleeding, expanding, or pulsatile hematoma. Currently, medical management with anticoagulation remains the first line of treatment and yields good outcomes in 75% of cases with a mortality rate of 3-4%. Endovascular intervention is indicated with failure of medical therapy, progressive enlargement of a traumatic pseudoaneurysm, acute flow-related infarcts due to vessel occlusion, or when anticoagulation is contraindicated due to risk of pseudoaneurysm rupture and hemorrhage. Recognized interventional treatments include parent artery occlusion with or without revascularization, endovascular coil embolization, and covered stenting. Summary: A wide variety of endovascular stents are available that are capable of opening a stenosed vessel while obliterating the associated false lumen and providing a scaffold for embolization of the pseudoaneurysm. The use of the Pipeline Embolization Device (PED) in the management of traumatic intracranial pseudoaneurysms has been described. However, there are few reports on the usage of the PED for treating traumatic extracranial ICA dissection and/or pseudoaneurysms. However, a potential complication of the use of PED in the extracranial ICA is a hypothetical tendency to migrate in a mobile vessel. Thus, the risk of migration of the PED has encouraged practitioners to adopt strategies to limit this risk. Key Messages: We describe different techniques employed to anchor the flow-diverting construct within tortuous, mobile vessels.

Endovascular management of a complex intracranial internal carotid artery dissection in an adolescent

Abstract Background Blunt cerebrovascular injury is an important cause of morbidity and mortality following head trauma. Intracranial vessel dissections, carotid-cavernous fistulae, and pseudo-aneurysms are uncommon traumatic vascular lesions with limited evidence to guide endovascular management. Case description We describe the case of a sixteen year old male patient suffering a traumatic paraclinoidal internal carotid artery (ICA) dissection with carotid-cavernous fistula and ophthalmic artery pseudo-aneurysm. Repeat angiography demonstrated worsening dissection prompting an endovascular parent vessel sacrifice following a passed balloon test occlusion. Relevant imaging is included. Conclusions Amongst new and developing stenting technologies as well as complex surgical solutions, utilizing a modern endovascular adaptation of simple Hunterian ligation to treat a complex multi-pronged pathology may in some cases represent the best available option. Given the limited published literature, our diagnostic and treatment approach may be informative to clinicians as well as inform an evidence based management approach in similar complex intracranial vascular injuries.

Pseudoaneurisma di origine traumatica localizzato in un seno sfenoidale fratturato

SUMMARYWe describe a case of traumatic intra-sphenoidal right internal carotid artery pseudoaneurysm lodged inside the fractured sphenoidal sinus that developed in a patient with a previous history of frontal and skull base fractures involving the sphenoid sinus and walls of the carotid canal, but with normal intracranial findings at early CT angiography. The patient presented two episodes of massive life-threatening delayed epistaxis before successful endovascular treatment combining the use of coils and an uncovered stent was instituted. This case report highlights that patients with head trauma who present sphenoid sinus fractures with or without massive epistaxis should be evaluated for the development of traumatic internal carotid artery pseudoaneurysm as soon as possible. If the first angiographic evaluation reveals normal findings, repeated epistaxis should prompt a second angiographic evaluation because psudoaneurysm takes time to develop. Early treatment with uncovered stent of the aneurysm can be a life-saving therapeutic approach.

Natural History and Management of Blunt Traumatic Pseudoaneurysms of the Internal Carotid Artery: The Harborview Algorithm Based Off a 10-Year Experience.

To define the natural history of, and treatment strategy for, blunt traumatic internal carotid artery (ICA) pseudoaneurysms. The natural history and management of traumatic ICA pseudoaneurysms is controversial. We retrospectively identified all traumatic ICA pseudoaneurysms diagnosed on head/neck computed tomographic angiography at a high-volume trauma center over a 10-year period. Radiographic and clinical data were recorded, and a treatment algorithm was derived. Forty-three pseudoaneurysms were diagnosed in 39 patients. All patients were treated with daily aspirin unless contraindicated, and 82% underwent daily transcranial Doppler ultrasonography with embolic monitoring. A rate of 8 or more emboli per hour was predictive of embolic stroke (P = 0.0076). Acute ischemic or embolic stroke was seen in 7 patients (16%) with an overall mortality in this subpopulation of 42% (n = 3). Four patients (9%) underwent acute surgical treatment (parent vessel sacrifice and/or arterial bypass) for ongoing ischemia. Long-term radiographic and clinical follow-up was obtained for 36 surviving patients (mean = 8 months; range: 1 week-5 years), all of whom were maintained on daily aspirin. No delayed ischemic or embolic events were reported. For ICA pseudoaneurysms treated with aspirin and observation alone, 9 (28%) increased in size, 17 (53%) decreased or stabilized, and 6 (19%) resolved. Enlargement of 5 mm or more in maximal diameter underwent delayed endovascular treatment with a 100% obliteration rate and no complications. Traumatic ICA pseudoaneurysms are safely treated with daily aspirin, embolic monitoring, and radiographic surveillance. Acute stroke or hemorrhage, or delayed radiographic progression, are indications for endovascular or surgical treatment.

Carotid artery thrombosis and cerebral infarction after multiple traumas

Carotid artery thrombosis and concomitant brain infarction after blunt trauma are rare conditions. We report a 34-year-old woman with multiple traumas due to pedestrian car accident. At the time of initial visiting, she was somnolent and her Glasgow coma scale (GCS) score was 14. Initial vital signs (V/S) and brain computed tomography (CT) scan were normal. One day after admission to the emergency observation unit, GCS improved to 15 but right-sided hemiparesis occurred. Magnetic resonance imaging (MRI) showed brain infarction and Doppler sonography indicated internal carotid artery thrombosis. She was admitted in the Neurosurgery ward and underwent anticoagulant therapy. With appropriate treatment, the patient’s condition improved after 5 days of admission and she was discharged on oral warfarin treatment and close follow up. Although there is no ideal treatment for traumatic internal carotid artery thrombosis, it seems that in most cases anticoagulation therapy is the preferred method of treatment but in some patients surgical or endovascular revascularization is indicated.

Traumatic Pseudoaneurysm of Internal Carotid Artery presenting as Intractable Epistaxis in a Case of Maxillary Fracture

ABSTRACT Traumatic pseudoaneurysm of internal carotid artery is a rare complication of injury after craniomaxillofacial trauma. Delayed recurrent epistaxis after head and facial trauma is the most distinctive manifestation of traumatic internal carotid artery pseudoaneurysm. Epistaxis due to pseudoaneurysm of internal carotid artery is difficult to control, and may lead to hemor- rhagic shock or asphyxia and thus seriously threatens life. The purpose of this paper is to present a rare case of recurrent epistaxis secondary to ICA pseudoaneurysm following blunt maxillofacial trauma. Endovascular stenting was performed and the recurrent epistaxis was successfully arrested. How to cite this article Kumar D, Sahu GR, Kumar A, Mukherjee KK, Rattan V. Traumatic Pseudoaneurysm of Internal Carotid Artery presenting as Intractable Epistaxis in a Case of Maxillary Fracture. J Postgrad Med Edu Res 2015;49(1):49-51.