Endovascular treatment of an open cervical fracture with carotid artery tear

Witz, Misha; Gepstein, Reuven; Paran, Haim; Shnaker, Ali; Lehmann, Jonathan; Gryton, Igal; Shabat, Shay

doi:10.1007/s00586-006-0182-0

Cited by 3 publications

(7 citation statements)

References 12 publications

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“…Additional features such as carotidynia and Horner's syndrome may be present. 3,18,19 The goal of diagnosis and treatment in asymptomatic patients is preservation of neurological function and, in patients with established neurological deficits, prevention of further deterioration and preserving the capacity for functional recovery. Treatment of traumatic carotid or vertebral artery dissection is individualized based on neurological function, collateral flow status and associated neurological and non-neurological injuries.…”

Section: Diagnostic Cerebral Angiography After Traumamentioning

confidence: 99%

“…33,34 Pseudoaneurysm Traumatic pseudoaneurysms can form after either blunt, penetrating or blast injuries to the head and neck and are often associated with other injuries to the carotid and vertebral arteries. 18 Symptoms occur due to distal embolization, parent vessel occlusion, local compression and bleeding. Traumatic pseudoaneurysms of the external carotid artery may cause refractory life-threatening epistaxis and upper airway compromise.…”

Section: Diagnostic Cerebral Angiography After Traumamentioning

confidence: 99%

“…36,37,39 Complete occlusion of the pseudoaneurysm with preservation of parent vessel is possible using a combination of embolization of the pseudoaneurysm using coils or gel foam, and stent angioplasty of the parent vessel. 18,24,36,37 In some cases, covered stents or overlapping stents alone may be sufficient for preservation of parent vessel and cure of pseudoaneurysm (Figure 1). For intracranial dissection, uncovered stents are typically used to preserve perforator vessels.…”

Section: Diagnostic Cerebral Angiography After Traumamentioning

confidence: 99%

“…Endovascular therapy overall is an effective and durable treatment for pseudoaneurysms (Table 3) (Figures 1 and 2). 18,36…”

Section: Diagnostic Cerebral Angiography After Traumamentioning

confidence: 99%

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Endovascular therapy for cerebrovascular injuries after head and neck trauma

Alderazi

Cruz

Kass‐Hout

et al. 2015

Trauma

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Cerebrovascular injuries after blunt or penetrating head and neck trauma often lead to significant disability from ischemic stroke, hemorrhagic stroke and uncontrolled extracranial hemorrhage. Trauma causes carotid or vertebral dissection, occlusion, pseudoaneurysm, arteriovenous fistula, vessel transection, traumatic epistaxis, venous sinus thrombosis and carotid cavernous fistula. The rapid development of neuroendovascular techniques over the past two decades has led to effective therapies for each of these injuries. Controlled lesion embolization may use coils, liquid embolics (onyx or n-butyl cyanoarcrylate), polyvinyl alcohol particles or detachable balloons; there is stent angioplasty with uncovered, overlapping and covered stents or mechanical thrombolysis using stent-retrievers or aspiration catheters and the use of balloon occlusion tests and supraselective angiography to delineate safety of vessel sacrifice and to diagnose occult lesions respectively. Furthermore, the proliferation of stroke centers has increased local availability of rapid neuroendovascular expertise at many major trauma centers. Neuroendovascular therapies are less invasive than surgery, can often preserve the injured parent vessels and aid in treating conditions where surgery may be limited. In the absence of randomized controlled trials we present a narrative review of current endovascular therapeutic applications for each of these injuries. This expands the therapies at trauma teams' disposal in the continued effort to control bleeding, reduce secondary injury and prevent disability after trauma. Further research is necessary to inform the role of endovascular techniques after trauma. In particular, comparative studies are necessary to quantify the risk and benefits in conditions where surgical options also exist.

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Section: Diagnostic Cerebral Angiography After Traumamentioning

confidence: 99%

Section: Diagnostic Cerebral Angiography After Traumamentioning

confidence: 99%

Section: Diagnostic Cerebral Angiography After Traumamentioning

confidence: 99%

“…Endovascular therapy overall is an effective and durable treatment for pseudoaneurysms (Table 3) (Figures 1 and 2). 18,36…”

Section: Diagnostic Cerebral Angiography After Traumamentioning

confidence: 99%

See 2 more Smart Citations

Endovascular therapy for cerebrovascular injuries after head and neck trauma

Alderazi

Cruz

Kass‐Hout

et al. 2015

Trauma

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“…These publications are summarized in Table 1 . [ 1 2 4 5 7 8 11 13 15 16 19 25 27 – 32 34 35 37 38 41 42 45 49 51 52 54 57 59 – 63 65 66 68 – 73 75 – 77 79 80 82 – 85 87 89 – 92 94 – 98 100 101 103 104 106 109 112 – 114 ]…”

Section: Review Of the Literaturementioning

confidence: 99%

Endovascular implantation of covered stents in the extracranial carotid and vertebral arteries: Case series and review of the literature

Alaraj¹,

Wallace²,

Amin‐Hanjani³

et al. 2011

Surg Neurol Int

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Background:Covered stents are used endovascularly to seal arterial wall defects while preserving vessel patency. This report describes our experience with the use of covered stents to treat cervical pathology, and a review of the literature in regards to this topic is presented.Case Description:Two patients presenting with the carotid blowout syndrome and one patient with a vertebrojugular fistula were treated with covered stents. This allowed for preservation of the vessel and was a treatment alternative to cerebral bypass.Conclusion:Covered stents provide a viable means of preserving the cervical vessels in selected patients; however, long-term follow-up is necessary to determine stent patency and permanency of hemostasis.

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Post-Traumatic Intracranial Pseudoaneurysm Presenting as Epistaxis

Hassan,

Donley,

Venkatachalam

2024

OAEM

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Background Epistaxis is a frequent presenting complaint in the Emergency Department (ED). Roughly 60% of the population will suffer from epistaxis in their lifetime. The most common causes of epistaxis include nose picking, facial trauma, foreign bodies, and coagulopathies. There are other causes that are much less common, such as intracranial pseudoaneurysms. There are multiple causes that precipitate intracranial pseudoaneurysm formation, with head trauma accounting for less than 1% of inciting events. Case Report A 24-year-old female with history of traumatic brain injury with associated skull fractures due to a gunshot wound to the head 6 months prior presented to the ED in hemorrhagic shock secondary to epistaxis. After stabilization with the administration of blood products, Computed Tomography with Angiography (CTA) imaging of the head and neck was obtained and revealed a 3.1 × 2.2 × 2.5 cm pseudoaneurysm of the cavernous portion of the right internal carotid artery penetrating through the base of the skull into the ethmoidal sinus. The patient was taken for formal angiography by interventional radiology-and a partially thrombosed daughter sac of the initial aneurysm was identified and believed to be the source of the hemorrhage. The aneurysm was successfully coiled and occluded using ONYX embolization. Postoperatively, the patient returned to her baseline mental status without any acute complaints. The patient was discharged back to her nursing home 2 days later with a 3-week follow-up CTA revealing persistent occlusion of the aneurysm and a patent internal carotid artery. Conclusion Awareness and consideration of intracranial vascular etiology for common complaints in the emergency room, such as Epistaxis, especially in patients with any history of head injury/trauma, known intracranial aneurysms or prosthetic devices from prior surgery may help guide decision-making in managing critically ill patients.

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Endovascular treatment of an open cervical fracture with carotid artery tear

Abstract: The dilemma of how to treat penetrating wound injuries to the neck, which involve a combination of a common carotid artery rupture and a cervical spinal fracture, is presented in this case report.

Cited by 3 publications

References 12 publications

Endovascular therapy for cerebrovascular injuries after head and neck trauma

Endovascular therapy for cerebrovascular injuries after head and neck trauma

Endovascular implantation of covered stents in the extracranial carotid and vertebral arteries: Case series and review of the literature

Post-Traumatic Intracranial Pseudoaneurysm Presenting as Epistaxis

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