Endoluminal Stent Placement and Coil Embolization for the Management of Carotid Artery Pseudoaneurysms

Bush, Ruth L.; Lin, Peter H.; Dodson, Thomas F.; Dion, Jacques E.; Lumsden, Alan B.

doi:10.1177/152660280100800109

Cited by 93 publications

(70 citation statements)

References 19 publications

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“…Endovascular techniques such as coil embolization and stent placement have gained increasing popularity in the treatment of blunt vascular injuries including pseudoaneurysm, fistula, and flow-limiting dissections. While some studies have raised concerns over the safety of endovascular techniques as a result of increased risks of stroke and stent occlusion 17,27,34 , other groups have reported good longterm results with endovascular treatment [35][36][37][38] . Specifically, endovascular occlusion has been advocated as a feasible and safe treatment for traumatic vertebral arteriovenous fistula 39,40 .…”

Section: Discussionmentioning

confidence: 99%

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Wei

Montanera

Selchen

et al. 2010

Can. j. neurol. sci.

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574In recent years, blunt cerebrovascular injury (BCVI) is gaining attention as an important sequela of nonpenetrating trauma to the neck and skull base. Blunt cerebrovascular injury affects approximately 1% of all blunt trauma admissions, and the reported incidence is as high as 2.7% in centres with aggressive screening protocols [1][2][3][4][5][6][7][8] . The pattern of BCVI consists of vascular transection, dissection, thrombosis, and formation of pseudoaneurysm or arteriovenous fistula (AVF) 9,10 . The majority of these injuries occur during motor vehicle accidents, with variable rates of carotid and vertebral artery involvement reported in the literature [11][12][13] . If untreated, BCVI can be fatal and result in devastating neurological sequelae, with mortality and morbidity rates reported up to 38% and 67% respectively 14 .One of the difficulties in initiating treatment for BCVI is related to the variable symptomatology. While approximately ABSTRACT: Background: Blunt cerebrovascular injury (BCVI) to the carotid and vertebral arteries is a potentially devastating injury in trauma patients. The optimal management for BCVI has not been standardized. At our institution, 64-slice multi-detector computed tomographic angiography (CTA) has been used as the initial screening exam for BCVI in patients who met predefined screening criteria. The purpose of this study is to review the incidence of CTA-diagnosed BCVI in at-risk patients and to evaluate the treatment and clinical outcome of patients with BCVI. Methods: This study included trauma patients with a positive diagnosis of BCVI on CTA during a 41-month study period. The medical records and relevant radiographic findings were retrospectively reviewed. Results: Twenty seven of 222 blunt trauma patients evaluated with CTA had a positive diagnosis of BCVI, with an occurrence rate of 12.2%. Traumatic brain injury (72.2%) and basal skull fractures (55.6%) were the most frequent associated injuries with carotid trauma while 100% of blunt vertebral injuries occurred in the setting of cervical fractures. Fourteen (51.8%) patients received medical therapy; Eleven (40.7%) patients received conservative treatment. Endovascular treatment was attempted in a single case of vertebral arteriovenous fistula. BCVI-related stroke was found in four patients (14.8%), one of whom developed an infarct while on medical treatment. Conclusions: BCVI is found in a significant portion of blunt trauma patients with identifiable risk factors, and screening CTA has high diagnostic yield in detecting these lesions. Medical therapy is the mainstay of treatment at our institution; however, BCVI-related stroke may occur despite treatment. RÉSUMÉ: Diagnostic et résultats du traitement des traumatismes cérébrovasclaires contondants. Contexte :Le traumatisme cérébrovasculaire contondant (TCVC) à la carotide et aux artères vertébrales est une lésion qui peut être dévastatrice chez les patients qui ont subi un traumatisme. Le traitement optimal du TCVC n'a pas été standardisé. Dans notre institutio...

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Section: Discussionmentioning

confidence: 99%

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Wei

Montanera

Selchen

et al. 2010

Can. j. neurol. sci.

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“…Endovascular embolization techniques using detachable coils can be used for the treatment of pseudoaneurysms. However, wide-neck aneurysms such as our case are difficult to treat, mainly because the detached coils are prone to migrate or herniate into the parent arteries, 3,4,8,12,13) so a modification of the simple coil embolization technique is necessary.…”

Section: Discussionmentioning

confidence: 99%

“…Pseudoaneurysms have been successfully treated by coil embolization with stenting, enabling preservation of the patency of the parent vessels as well as obliteration of the aneurysm. 4,8,10,12,13) Most of these pseudoaneurysms were idiopathic, 10) or secondary to trauma or direct neurosurgical procedures. 4,8,12,13) Two cases of pseudoaneurysms of the vertebral arteries secondary to endovascular procedures were treated by coil embolization combined with stenting.…”

Section: Introductionmentioning

confidence: 99%

“…4,8,10,12,13) Most of these pseudoaneurysms were idiopathic, 10) or secondary to trauma or direct neurosurgical procedures. 4,8,12,13) Two cases of pseudoaneurysms of the vertebral arteries secondary to endovascular procedures were treated by coil embolization combined with stenting. 13) We treated a patient with a carotid pseudoaneurysm subsequent to an endovascular procedure, which was successfully obliterated by the stent-supported coil embolization technique.…”

Section: Introductionmentioning

confidence: 99%

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Stent-Supported Coil Embolization for Carotid Artery Pseudoaneurysm as a Complication of Endovascular Surgery-Case Report-

Koyanagi

Nishi

Hattori

et al. 2004

Neurol. Med. Chir.(Tokyo)

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A 57-year-old male presented with right amaurosis fugax and left transient ischemic attack caused by stenosis of the intracranial segment of the right internal carotid artery (ICA). Percutaneous transluminal angioplasty with stenting was successfully performed to dilate the stenosis. However, serial angiography revealed the development of a large pseudoaneurysm in the cervical ICA, probably as a result of carotid wall injury caused by the guiding catheter during the procedures. The patient underwent a second endovascular angioplasty. A Palmaz stent was placed across the aneurysm neck to stabilize the carotid wall. Guglielmi detachable coils were then inserted into the aneurysm cavity through the stent struts to successfully obliterate the aneurysm. Both the angiographical results and the patient's outcome were favorable. Stent-supported coil embolization is an effective and safe technique for medically refractory pseudoaneurysms, and may be a useful alternative to direct surgery.

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“…Bush et al 10 reported the treatment of ICA pseudoaneurysms due to blunt carotid injury by placing bare stents and adding coil embolization of the excluded pseudoaneurysm in 5 patients; occlusion of all 5 pseudoaneurysms resulted. At follow-up (mean, 11.7 months) all 5 pseudoaneurysms remained occluded, with 4 of 5 stents remaining widely patent; 1 of the 4 had developed a 60% focal stenosis.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Carotid and Vertebral Pseudoaneurysms with Covered Stents

Yi¹,

Palmer²,

Luh³

et al. 2008

AJNR Am J Neuroradiol

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Endoluminal Stent Placement and Coil Embolization for the Management of Carotid Artery Pseudoaneurysms

Abstract: Endovascular treatment of carotid artery pseudoaneurysms is a useful alternative to standard surgical repair. This modality avoids the necessity for surgical exposure at the skull base with its inherent morbidity.

Cited by 93 publications

References 19 publications

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Stent-Supported Coil Embolization for Carotid Artery Pseudoaneurysm as a Complication of Endovascular Surgery-Case Report-

Endovascular Treatment of Carotid and Vertebral Pseudoaneurysms with Covered Stents

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