Carotid trauma endovascular

OBJECTIVES: While methods of endovascular carotid artery stenting have improved over time, concerns surrounding the safety and efficacy of stenting for blunt carotid injury (BCI) remain. This study aims to present our approach to carotid artery stenting (CAS) by incorporating new technologies such as flow-diverting stents and circuits. METHODS: There is no robust evidence to support routine carotid artery stenting; however, there are several therapeutic options and approaches for treating BCI that currently require an individualized approach...

OBJECTIVE: Blunt traumatic thoracic aortic injuries (BTAI) are associated with a high mortality rate. Thoracic endovascular aortic repair (TEVAR) is the most used surgical strategy in patients with BTAI, as it offers good short- and middle-term results. Previous studies have reported an abnormally-high prevalence of hypertension (HT) in these patients. This work aims to describe the long-term prevalence of HT and provide a comprehensive evaluation of the biomechanical, clinical and functional factors involved in HT development...

BACKGROUND: Endovascular balloon occlusion of the aorta (EBOA) increases proximal arterial pressure but may also induce life-threatening ischemic complications. Although partial REBOA (P-REBOA) mitigates distal ischemia, it requires invasive monitoring of femoral artery pressure for titration. In this study, we aimed to titrate P-REBOA to prevent high-degree P-REBOA using ultrasound assessment of femoral arterial flow. METHODS: Proximal (carotid) and distal (femoral) arterial pressures were recorded, and perfusion velocity of distal arterial pressures was measured by pulse wave Doppler...

Major vascular traumas to the neck, upper limbs, and chest may arise from penetrating and/or blunt mechanisms, resulting in a range of clinical scenarios. Lesions to the carotid arteries may also lead to neurologic complications, such as stroke. The increasing use of invasive arterial access for diagnostic and/or interventional purposes has increased the rate of iatrogenic injuries, which usually occur in older and hospitalized patients. Bleeding control and restoration of perfusion represent the two main goals of treatment for vascular traumatic lesions...

Traumatic cervical arteriovenous fistulas are rare, accounting for only 4% of all arteriovenous fistulas. They can be caused by penetrating, or rarely, blunt trauma, resulting in high-pressure arterial blood draining directly into a vein, decreasing distal perfusion. They are seldom reported as a complication of a carotid paraganglioma surgical resection. Historically, arteriovenous fistulas were treated initially conservatively, after that, surgically; nowadays, endovascular treatment, when feasible, is the preferred method as it offers advantages over surgery...

BACKGROUND AND OBJECTIVES: Carotid-cavernous fistulas (CCFs) represent a group of rare, abnormal arteriovenous communications between the carotid arterial system and the cavernous sinuses (CS). CCFs often produce ophthalmologic symptoms related to increased CS pressures and retrograde venous drainage of the eye. Although endovascular occlusion remains the preferred treatment for symptomatic or high-risk CCFs, most of the data for these lesions is limited to small, single-center series...

Carotid artery injuries are rare with an incidence of 1%-2.6% in trauma patients. They are associated with high morbi-mortality rates, with mortality ranging from 19% to 43%. The diagnosis relies mainly on computed tomography angiography in the emergency setting; however, it is fundamental to be able to suspect carotid artery injuries on non-contrast computed tomography, as the latter is the routine imaging tool for trauma patients. We report the case of a young male, victim of a blunt high velocity motor-vehicle trauma...

BACKGROUND: The utilization of flow diverters (FDs) in the treatment of high-flow Type A carotid cavernous fistulas (CCFs) has been described before mainly as an adjunct to the traditional endovascular techniques and rarely as a stand-alone treatment. In this study, we retrospectively evaluated our experience with FDs as the solo nonadjunctive treatment of Type A CCF with severe cortical venous reflux (CVR). METHODS: A retrospective review was performed of patients with Type A CCFs who were treated using FDs' patch technique (PT)...

OBJECTIVE: Noncompressible torso hemorrhage is a high-mortality injury. We previously reported improved outcomes with a retrievable rescue stent graft to temporize aortic hemorrhage in a porcine model while maintaining distal perfusion. A limitation was that the original cylindrical stent graft design prohibited simultaneous vascular repair, given the concern for suture ensnarement of the temporary stent. We hypothesized that a modified, dumbbell-shaped design would preserve distal perfusion and also offer a bloodless plane in the midsection, facilitating repair with the stent graft in place and improve the postrepair hemodynamics...

INTRODUCTION: Endovascular techniques are increasingly used to repair major traumatic vascular injuries, but most endovascular implants are not designed/approved for trauma-specific indications. No inventory guidelines exist for the devices used in these procedures. We aimed to describe the use and characteristics of endovascular implants used for repair of vascular injuries to allow for better inventory management. METHODS: This CREDiT study is a six-year retrospective cohort analysis of endovascular procedures performed for repair of traumatic arterial injuries at five participating US trauma centers...

BACKGROUND: To evaluate the safety and efficacy of endovascular treatment with a combination of Onyx and coils for carotid cavernous fistulas (CCFs), and to characterize the factors associated with clinical and angiographic outcomes for direct and indirect CCFs. METHODS: This retrospective study included 31 patients with CCF treated with an endovascular procedure between December 2017 and March 2022. RESULTS: Direct and indirect CCFs were found in 14 (45...

Young adults who present to the ED with neck pain following non-penetrating, seemingly trivial trauma to the neck, are at risk of neck artery dissection and subsequent stroke. Sport-related neck injury is the chief cause. Physical examination may often be unremarkable, and although there may be reluctance to expose young patients to radiation, radiological imaging is central to making a diagnosis of arterial wall disruption. A comprehensive literature search was performed in relation to neck artery dissection, and the evidence was scrutinised...

BACKGROUND: Aortic pseudoaneurysm is a life-threatening clinical condition, and thoracic endovascular aortic repair (TEVAR) has been reported to have a relatively satisfactory effect in aortic pathologies. We summarized our single-centre experience using chimney TEVAR for aortic arch pseudoaneurysms with inadequate landing zones. METHODS: A retrospective study was conducted from October 2015 to August 2020, 32 patients with aortic arch pseudoaneurysms underwent chimney TEVAR to exclude an aortic lesion and reconstruct the supra-aortic branches, including 3 innominate artery, 12 left common carotid arteries and 29 left subclavian arteries...

Spontaneous internal carotid artery dissection (ICAD) is a rare disease and an important cause of stroke in young patients. The presentation of ICAD is variable and atypical. We have used three-dimensional T1-weighted volume isotropic turbo spin-echo acquisition to help diagnose ICAD. ICAD should be considered in young patients presenting with relevant symptoms in an emergency setting. We herein report ICAD with an unexplained onset in two patients. Neither had a history of large or small cervical trauma, but both had a history of hypertension...

OBJECTIVE: Carotid bifurcation revascularization using interposition grafts is rare. While internal carotid artery (ICA) revascularization is regarded as mandatory, the external carotid artery (ECA) is severed in most instances. Long-term results of an autologous bifurcated carotid artery reconstruction are discussed. METHODS: Single centre, retrospective analysis of a consecutive series of patients treated at an academic vascular surgery center. RESULTS: From 12/2006 to 11/2019, fifty-one patients underwent reconstruction of the carotid artery using an autologous bifurcated interposition graft (38 male, 75%; median age: 68...

Bilateral carotid-cavernous fistula (CCF) is a rare complication associated with severe head injury and skull base fractures. Initial presentation with hemodynamically relevant epistaxis is unusual. We report a case of a 27-year-old male presenting with severe craniocerebral injury associated with massive epistaxis. To stabilize the patient hemodynamically, the bleeding was stopped by embolization of left internal carotid artery with coils, after checking that the Willis circle is well compensated. The left CCF was embolized later with flow diverter stent when it was safe to use platelet aggregation inhibitors...

Post-traumatic unilateral carotid cavernous fistula (CCF) with ipsilateral symptoms is a rare occurrence, so its diagnosis frequently gets overlooked for other more common conditions. Timely imaging with digital subtraction angiography (DSA) and appropriate vascular intervention is essential in preventing potentially serious sequelae in such cases. We describe a case of post-traumatic CCF in a 42-year-old man who experienced intermittent headaches and right eye redness, proptosis, and watery discharge for three months following the incident...

BACKGROUND: Pediatric cerebrovascular trauma (CVT) is rare. There is an increasing use of endovascular management in vascular trauma. We studied the incidence, management, and outcomes of CVT in the pediatric population using the NTDB (National Trauma Data Bank). METHODS: The NTDB was queried for CVT in patients less than 18 years of age over a recent three-year period (2017-2019). Demographics, injury mechanism, type and location, Glasgow Coma Score (GCS), length of stay (LOS), surgical approach (open vs endovascular), and morbidity/mortality were evaluated...

Life-threatening hemorrhage following maxillofacial injury (MFI) is rare but can be fatal. Conventional measures for hemostasis including nasal packing, balloon tamponade, and surgical ligation of bleeding points may not be effective or efficient in patients at risk of hypovolemic shock. Advantages of transarterial embolization (TAE) include rapid identification of the bleeding focus and its access, direct obstruction of the culprit vessels, ability to control multiple bleeding sites, and no requirement of general anesthesia...

RATIONALE: Traumatic carotid-cavernous sinus fistula (TCCF) is a pathological shunt between the carotid arteries and cavernous sinus due to trauma. Imaging-guided (e.g., ultrasonic image and fluoroscopic roadmap image) direct puncture of the superior ophthalmic vein (SOV) for embolization of TCCF has been previously described in other studies. PATIENT CONCERNS AND DIAGNOSIS: We report a case of TCCF in a 58-years-old male patient who was admitted to our hospital with a sustained head injury after falling from a high platform, resulting in rapidly progressive swelling, pain, diminishing vision for more than 6 months, and blindness in his left eye for 1 month...