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Carotid trauma endovascular

Michael C Dewan, Vijay M Ravindra, Stephen Gannon, Colin T Prather, George L Yang, Lori C Jordan, David Limbrick, Andrew Jea, Jay Riva-Cambrin, Robert P Naftel
BACKGROUND: Pediatric blunt cerebrovascular injury (BCVI) lacks accepted treatment algorithms, and postinjury outcomes are ill defined. OBJECTIVE: To compare treatment practices among pediatric trauma centers and to describe outcomes for available treatment modalities. METHODS: Clinical and radiographic data were collected from a patient cohort with BCVI between 2003 and 2013 at 4 academic pediatric trauma centers. RESULTS: Among 645 pediatric patients evaluated with computed tomography angiography for BCVI, 57 vascular injuries (82% carotid artery, 18% vertebral artery) were diagnosed in 52 patients...
July 25, 2016: Neurosurgery
Arthur Wang, Justin G Santarelli, Michael F Stiefel
PURPOSE: Optimal management of extracranial carotid artery dissections (eCAD) in pediatric patients is not well documented, and endovascular interventions are rarely reported. METHODS: A 10-year-old girl sustained multiple systemic injuries in a motor vehicle accident, including an eCAD with pseudoaneurysm. She initially failed both aspirin and endovascular stenting with progressive enlargement of a traumatic cervical carotid pseudoaneurysm and stenosis. RESULTS: Second-stage endovascular stent placement with coiling resulted in successful occlusion of the pseudoaneurysm...
July 12, 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
P Pelliccia, M Bartolomeo, G Iannetti, A Bonafé, M Makeieff
We 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...
April 2016: Acta Otorhinolaryngologica Italica
Jordan A Weinberg, Andrew H Moore, Louis J Magnotti, Rebecca J Teague, Tyler A Ward, Joshua B Wasmund, Elena M P Lamb, Thomas J Schroeppel, Stephanie A Savage, Gayle Minard, George O Maish, Martin A Croce, Timothy C Fabian
BACKGROUND: The management of arterial injury at the thoracic outlet has long hinged on the fundamental principles of extensile exposure and vascular anastomosis. Nonetheless, treatment options for such injuries have evolved to include both endovascular stent placement and temporary vascular shunts. The purpose of this study was to evaluate our recent experience with penetrating cervicothoracic arterial injuries in light of these developments in trauma care. METHODS: Patients with penetrating injuries to the innominate, carotid, subclavian, or axillary arteries managed at a single civilian trauma center between 2000 and 2013 were categorized as the modern era (ME) cohort...
August 2016: Journal of Trauma and Acute Care Surgery
Gennadiy A Katsevman, John A Braca, Kevin C Welch, William W Ashley
BACKGROUND: Epistaxis is a very common medical condition and can often be controlled with conservative measures. Rarely, uncontrolled and life-threatening epistaxis can occur. CASE DESCRIPTION: We present the case of a 58-year-old man who developed delayed, massive epistaxis caused by an extracranial left internal carotid artery pseudoaneurysm caused by an intranasal foreign object without apparent recent trauma. The patient was successfully treated with endovascular stenting of the affected vessel segment...
August 2016: World Neurosurgery
Alexander P Marston, Monique M Montenegro, Michael S Oldenburg, Joshua T Thom, Colin L W Driscoll
OBJECTIVES: Describe the presentation and treatment of a patient who suffered a penetrating cervical trauma resulting in occlusion of the vertebral and internal carotid arteries. METHODS: The electronic medical record was used to collect information pertaining to the patient's clinical history. RESULTS: A 20-year-old male suffered a unique penetrating neck injury resulting in simultaneous injuries to the internal carotid and vertebral arteries as demonstrated by pre-operative angiography...
May 2016: American Journal of Otolaryngology
Tae Hun Moon, Sung Han Kim, Jae Whan Lee, Seung Kon Huh
OBJECTIVE: Traumatic pseudoaneurysms are rare but life-threatening lesions. We investigated the patients with these lesions to clarify their clinical characteristics and therapeutic strategies and we also reviewed the literatures on the treatment principles, possible options, and outcomes. METHODS: There were a total of 8 patients who were treated with traumatic intracranial pseudoaneurysms between April 1980 and January 2009. Medical charts and the imaging studies were reviewed for analysis...
October 2015: Korean Journal of Neurotrauma
Peter S Y Yu, Simon C H Yu, Cyrus T C Ng, Micky W T Kwok, Simon C Y Chow, Jacky Y K Ho, Malcolm J Underwood, Randolph H L Wong
A 57-year-old man was incidentally found to have a dissected diverticulum of Kommerell originating from aberrant origin of right subclavian artery during follow-up for treated colon cancer. A right carotid-axillary bypass was followed by embolization of aberrant artery and the diverticulum by deployment of multiple detachable coils using the Penumbra Ruby System (Penumbra, Alameda, CA). Angiography after embolization showed exclusion of flow to the aberrant artery and a patent right carotid-axillary bypass...
May 2016: Annals of Thoracic Surgery
Bin Du, Meng Zhang, Qing-Lin Liu, Jie Shen, Yun-Yan Wang
Carotid-cavernous fistulas (CCFs) are an abnormal vascular shunt between the carotid artery and the cavernous sinus, and were traditionally classified into four subtypes based on the detailed fistulas anatomy and arterial supply. CCFs are frequently encountered in patients with traumatic skull base fractures. In this report, we present one such case caused by two head traumas. Computed tomography and digital subtraction angiography confirmed that this CCF arose from posterior communicating artery of the internal carotid artery, which is not included in the traditional Barrow et al's categorization...
2016: Neuropsychiatric Disease and Treatment
Alexander Gombert, Mohammad Esmaeil Barbati, Jochen Grommes, Houman Jalaie, Karina Schleimer, Michael J Jacobs, Johannes Kalder
BACKGROUND: Blunt thoracic aortic injuries (BTAIs) are rare but life threatening. Most BTAI are caused by high-energy trauma. Among children with blunt trauma, the incidence of BTAI is below 1 percent. The present case deals with covered thoracic aortic rupture of a 15-year-old boy. Emphasizing the value and the difficulties of endovascular surgery in children is the motivation for this case report. CASE REPORT: We are presenting the case of a 15-year-old boy, who suffered multiple traumata after accident...
May 2016: Annals of Vascular Surgery
Petar Popov, Rene Chapot, Slobodan Tanasković, Berislav Vekić, Vuk Sotirovic, Nenad Ilijevski, Djordje Radak
INTRODUCTION: Spontaneous dissection of supra-aortic arteries is an exceptionally rare cause of vocal cord dysfunction. We are reporting a case of spontaneous carotid dissection and internal carotid artery aneurysm presenting as vocal cord paralysis. CASE REPORT: A 44-year-old female was admitted with hoarseness and swallowing disorders. Diagnostic imaging revealed dissection and obliteration of the right internal carotid artery (ICA) 23 mm from the carotid bifurcation...
January 2016: Vascular and Endovascular Surgery
Megan Brenner, Melanie Hoehn, William Teeter, Deborah Stein, Thomas Scalea
BACKGROUND: The skill set of the acute care surgeon can be expanded by formal training. We report the first series of traumatic vascular injury (TVI) treated by acute care surgeons trained in endovascular techniques (ACSTEV). METHODS: We retrospectively reviewed patients admitted to our trauma center with TVI over 5 months who survived for more than 24 hours and had catheter diagnosis and/or therapy by ACSTEV. Demographics, admission data, and outcomes were reviewed...
May 2016: Journal of Trauma and Acute Care Surgery
Hosam M Al-Jehani, Hassan A Alwadaani, Fadhel M Almolani
Traumatic intracranial pseudoaneurysm is a rare complication of blunt trauma. It is even more rare when it presents as epistaxis. Massive epistaxis of a ruptured intracranial internal carotid artery pseudoaneurysm is a major cause of mortality, which requires emergency intervention. We report a case of traumatic intracranial internal carotid artery pseudoaneurysm secondary to skull base fracture, which presented with delayed onset of epistaxis. This was successfully treated by primary endovascular coil embolization...
January 2016: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
D J J Muckart, B Pillay, T C Hardcastle, D L Skinner
INTRODUCTION: Motor vehicle collisions account for the majority of blunt vascular trauma. Much of the literature describes the management of these injuries in isolation, and there is little information concerning the incidence and outcome in patients suffering multiple trauma. This study was undertaken to describe the spectrum of blunt vascular injuries in polytrauma patients. PATIENTS AND METHODS: All patients who had sustained blunt vascular trauma over a 6-year period (April 2007-March 2013) were identified from a prospectively gathered database at the Level I Trauma Unit, Inkosi Albert Luthuli Central Hospital, Durban, South Africa...
June 2014: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Frank M Davis, Jonathan L Eliason, Santhi K Ganesh, Neal B Blatt, James C Stanley, Dawn M Coleman
OBJECTIVE: Pediatric arterial aneurysms are extremely uncommon. Indications for intervention remain poorly defined and treatments vary. The impetus for this study was to better define the contemporary surgical management of pediatric nonaortic arterial aneurysms. METHODS: A retrospective analysis was conducted of 41 children with 61 aneurysms who underwent surgical treatment from 1983 to 2015 at the University of Michigan. Arteries affected included: renal (n = 26), femoral (n = 7), iliac (n = 7), superior mesenteric (n = 4), brachial (n = 3), carotid (n = 3), popliteal (n = 3), axillary (n = 2), celiac (n = 2), ulnar (n = 2), common hepatic (n = 1), and temporal (n = 1)...
February 2016: Journal of Vascular Surgery
Roland P Nooij, J M C Marc van Dijk, Rob J M Groen, Maarten Uyttenboogaart, Omid S Eshghi, Astrid G W Kosten-Meijer
BACKGROUND: Epistaxis is a common problem, which is usually benign in nature. In some cases, however, epistaxis is a symptom of a severe underlying condition. CASE DESCRIPTION: A 20-year-old male was treated conservatively following head injury with craniofacial and base-of-skull fractures. Recurrent episodes of epistaxis occurred some weeks after treatment. Further investigation showed an extradural dissecting aneurysm of the left internal carotid artery (ICA), projecting into the sphenoid sinus...
2015: Nederlands Tijdschrift Voor Geneeskunde
Sundeep Mangla, Jae H Choi, Frank C Barone, Carol Novotney, Jenny Libien, Erwin Lin, John Pile-Spellman
BACKGROUND: The choice of an animal model for cerebrovascular research is often determined by the disease subtype to be studied (e.g. ischemic stroke, hemorrhage, trauma), as well as the nature of the intervention to be tested (i.e. medical device or pharmaceutical). Many initial studies are performed in smaller animals, as they are cost-effective and their encephalic vasculature closely models that of humans. Non-human primates are also utilized when confirmation or validation is required on higher levels and to test larger devices...
2015: BMC Research Notes
Miklos G Marosfoi, Netanel Korin, Matthew J Gounis, Oktay Uzun, Srinivasan Vedantham, Erin T Langan, Anne-Laure Papa, Olivia W Brooks, Chris Johnson, Ajit S Puri, Deen Bhatta, Mathumai Kanapathipillai, Ben R Bronstein, Ju-Yu Chueh, Donald E Ingber, Ajay K Wakhloo
BACKGROUND AND PURPOSE: The goal of this study is to combine temporary endovascular bypass (TEB) with a novel shear-activated nanotherapeutic (SA-NT) that releases recombinant tissue-type plasminogen activator (r-tPA) when exposed to high levels of hemodynamic stress and to determine if this approach can be used to concentrate r-tPA at occlusion sites based on high shear stresses created by stent placement. METHODS: A rabbit model of carotid vessel occlusion was used to test the hypothesis that SA-NT treatment coupled with TEB provides high recanalization rates while reducing vascular injury...
December 2015: Stroke; a Journal of Cerebral Circulation
J Pillai, C Yazicioglu, T Monareng, T B Rangaka, R Jayakrishnan, M G Veller
BACKGROUND: Blunt thoracic aortic injuries (BTAIs) remain a leading cause of death after blunt trauma. In severe injuries, thoracic endovascular aortic repair (TEVAR) has provided a less invasive alternative to conventional open repair. OBJECTIVE: To report the TEVAR-related complications and uncertainties in patients who presented with traumatic pseudoaneurysms (grade III BTAI). METHODS: From April 2004 to February 2012, 55 patients (42 male, mean age 34...
March 2015: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
Kareem Abed, Amit Misra, Viren Vankawala
This case report describes a patient found to have amaurosis fugax as a result of non-traumatic internal carotid dissection. Monocular blindness can be due to multiple causes including keratitis, acute glaucoma, vitreous hemorrhage, uveitis, retinal vascular occlusion, retinal detachment, optic neuropathy, trauma, or vascular malformations. In the setting of headache, neck pain, and an otherwise normal ophthalmic examination, this case report highlights the importance of recognizing transient ischemic attack and carotid artery dissection in the differential diagnosis...
2015: Journal of Community Hospital Internal Medicine Perspectives
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