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Wan L, Song Y, Li Z, Wang M, Song F, Zhang J, Zou D, Liu N, Shi Y, Zhang Z. Detection of traumatic internal carotid artery pseudoaneurysm by postmortem imaging: A case report. Medicine (Baltimore) 2022; 101:e28544. [PMID: 35029212 PMCID: PMC8758031 DOI: 10.1097/md.0000000000028544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 12/21/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Postmortem imaging (PMI), including computed tomography (PMCT), postmortem computed tomography angiography (PMCTA), and postmortem magnetic resonance imaging (PMMRI), is rapidly becoming effective and a practical method in forensic medicine. This study aimed to present a specific forensic case in which the PMI approach and its applications were used. PATIENT CONCERNS A 40-year-old male patient had moderate unilateral nose bleeding constantly 10 times after suffering from a head injury induced by a car accident. After a bilateral massive nose bleeding for the last time, he died from hemorrhagic shock. Traumatic internal carotid artery pseudoaneurysm (TICAP) was suspected in this patient. DIAGNOSIS, INTERVENTIONS, AND OUTCOMES A whole-body scanning was performed using PMCT and PMMRI. Then, PMCTA using left ventricular cardiac puncture was also implemented. A water-soluble contrast agent was injected into the left ventricle and pumped toward the intracranial, followed by a repeated whole-body PMCT scan. The PMCT/PMMRI detected a high-density/signal mass inside the left sphenoid sinus. The PMCTA detected a distinct leakage of the contrast agent into the left sphenoid sinus from an adjacent aneurysm of the C3 section of the left internal carotid artery. Autopsy and histology confirmed a TICAP inside the sphenoid sinus. LESSONS This case showed that the PMI was of great value for identifying the cause of death in special cases. When vascular lesions are suspected in the body, PMI and especially the PMCTA approach may be an effective detection method.
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Affiliation(s)
- Lei Wan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Yanxiang Song
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Zhengdong Li
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Maowen Wang
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Fengxiang Song
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jianhua Zhang
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Donghua Zou
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Ningguo Liu
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhiyong Zhang
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Figueroa JM, Berry K, Boddu J, Kader M, Silva M, Luther E, Ayala V, Starke RM, Jagid J, Benveniste R. Treatment strategies for patients with concurrent blunt cerebrovascular and traumatic brain injury. J Clin Neurosci 2021; 88:243-250. [PMID: 33992192 DOI: 10.1016/j.jocn.2021.03.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/20/2021] [Accepted: 03/31/2021] [Indexed: 01/17/2023]
Abstract
Patients who present with traumatic brain injury (TBI) combined with blunt cerebrovascular injuries (BCVI) are difficult to manage, in part because treatment for each entity may exacerbate the other. It is necessary to develop a treatment paradigm that ensures maximum benefit while mitigating the opposing risks. A cohort of 150 patients from 2015 to present, with either internal carotid artery (ICA) and/or vertebral artery (VA) dissections or pseudoaneurysms, was cross-referenced with those who had sustained TBI. Of the 38 patients identified with both TBI and BCVI, 25 suffered ICA injuries, 10 had VA injuries and 3 had combined ICA/VA injuries. Unilateral BCVI occurred in 30 patients, while 8 had bilateral BCVI. Two patients required surgical intervention for TBI, and 5 patients required endovascular intervention for BCVI. Positive emboli detection studies (EDS) on transcranial dopplers (TCD) were demonstrated in 19 patients, with 9 patients having radiographic evidence of stroke. Anti-platelet therapy was initiated in 32 patients, and anti-coagulation in 10 patients, without new or worsening intracranial hemorrhages (ICH). Overall, 76% of patients were able to be discharged home or to rehabilitation, with good recovery demonstrated in 73% of the patients who had appropriate follow-up. In the setting of concurrent TBI and BCVI, use of anti-platelet/coagulation to prevent stroke can be safe if monitored closely. Here we describe a treatment paradigm which weighs the risk and benefits of therapies based on severity of ICH and stroke prevention, which tended to result in good disposition and recovery.
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Affiliation(s)
- Javier M Figueroa
- University of Miami Miller School of Medicine, Department of Neurosurgery, USA.
| | - Katherine Berry
- University of Miami Miller School of Medicine, Department of Neurosurgery, USA
| | - James Boddu
- University of Miami Miller School of Medicine, Department of Neurosurgery, USA
| | - Michael Kader
- University of Miami Miller School of Medicine, Department of Neurosurgery, USA
| | - Michael Silva
- University of Miami Miller School of Medicine, Department of Neurosurgery, USA
| | - Evan Luther
- University of Miami Miller School of Medicine, Department of Neurosurgery, USA
| | - Veronica Ayala
- University of Miami Miller School of Medicine, Department of Neurosurgery, USA
| | - Robert M Starke
- University of Miami Miller School of Medicine, Department of Neurosurgery, USA
| | - Jonathan Jagid
- University of Miami Miller School of Medicine, Department of Neurosurgery, USA
| | - Ronald Benveniste
- University of Miami Miller School of Medicine, Department of Neurosurgery, USA
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Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2020; 88:875-887. [DOI: 10.1097/ta.0000000000002668] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Wang K, Peng XX, Liu AF, Zhang YY, Lv J, Xiang L, Liu YE, Jiang WJ. Covered Stenting Is an Effective Option for Traumatic Carotid Pseudoaneurysm with Promising Long-Term Outcome. J Korean Neurosurg Soc 2020; 63:590-597. [PMID: 32272508 PMCID: PMC7477158 DOI: 10.3340/jkns.2019.0202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/14/2020] [Indexed: 11/27/2022] Open
Abstract
Objective Covered stenting is an optional strategy for traumatic carotid pseudoaneurysm, especially in malignant conditions of potential rupture, but the long-term outcomes are not clear. Our aim was to determine if covered stenting is an effective option for traumatic carotid pseudoaneurysm with promising long-term outcomes.
Methods Self-expanding Viabahn and balloon-expandable Willis covered stents were separately implanted for extra- and intracranial traumatic carotid pseudoaneurysm. The covered stent was placed across the distal and proximal pseudoaneurysm leakage under roadmap guidance. Procedural success was defined as technical success (complete exclusion of the pseudoaneurysm and patency of the parent artery) without a primary end point (any stroke or death within 30 days after the procedure). Long-term outcomes were evaluated as ischemic stroke in the territory of the qualifying artery by clinical follow-up through outpatient or telephone consultation and as the exclusion of the pseudoaneurysm and patency of the parent artery by imaging follow-up through angiography.
Results Five patients with traumatic carotid pseudoaneurysm who underwent covered stenting were enrolled. The procedural success rate was 100%. No ischemic stroke in the territory of the qualifying artery was recorded in any of the five patients during a mean clinical follow-up of 44±16 months. Complete exclusion of the pseudoaneurysm and patency of the parent artery were maintained in all five patients during a mean imaging follow-up of 39±16 months.
Conclusion Satisfactory procedural and long-term outcomes were obtained, suggesting that covered stenting is an effective option for traumatic carotid pseudoaneurysm.
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Affiliation(s)
- Kai Wang
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Xiao-Xin Peng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Ao-Fei Liu
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Ying-Ying Zhang
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Jin Lv
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Li Xiang
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Yun-E Liu
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Wei-Jian Jiang
- New Era Stroke Care and Research Institute, The PLA Rocket Force Characteristic Medical Center, Beijing, China
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Carotide-jugular fistula due to vascular trauma with chain saw. Diagnostic and surgical approach. ANGIOLOGIA 2020. [DOI: 10.20960/angiologia.00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Arai N, Nakamura A, Tabuse M, Miyazaki H. Late-Onset Massive Epistaxis due to a Ruptured Traumatic Internal Carotid Artery Aneurysm: A Case Report. NMC Case Rep J 2017; 4:33-36. [PMID: 28664023 PMCID: PMC5364905 DOI: 10.2176/nmccrj.cr.2016-0139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/13/2016] [Indexed: 11/22/2022] Open
Abstract
A traumatic internal carotid artery (ICA) aneurysm is rare and difficult to treat. Trapping of ICA is commonly performed owing to the difficulty of directly approaching ICA aneurysms. Recently, coiling the aneurysm itself was recommended if possible. However, it is controversial which of methods are best to completely treat aneurysm. We present the case of a 74-year-old man, who had experienced a head injury 8 years previously, with recurrent severe epistaxis. An ICA aneurysm was detected on computed tomography. The trapping and bypass was planned. However, sudden epistaxis occurred, we performed trapping to stop the bleeding and save his life. After the operation, no right ICA or aneurysm was detected. However, severe epistaxis recurred two months after the operation. In the second operation, a ligation of the common -/- external carotid artery and a severance of an ICA portion between the ophthalmic artery and the aneurysm were insufficient to stop the bleeding. This case indicates ICA trapping, even if a trapping portion is below an ophthalmic artery, is insufficient to treat an ICA aneurysm. ICA aneurysms should be suspected when a patient present with recurrent -/- massive epistaxis, who has a head injury history, even if it is far past.
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Affiliation(s)
- Nobuhiko Arai
- Department of Neurological Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan
| | - Akiyoshi Nakamura
- Department of Neurological Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan
| | - Masanao Tabuse
- Department of Neurological Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan
| | - Hiromichi Miyazaki
- Department of Neurological Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan
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Nakamura H, Fujinaka T, Tasaki O, Yoshimine T. Delayed massive epistaxis from traumatic intracranial aneurysm after blunt facial injury. Acute Med Surg 2016; 4:131-134. [PMID: 29123850 PMCID: PMC5667291 DOI: 10.1002/ams2.239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 07/29/2016] [Indexed: 12/15/2022] Open
Abstract
Cases Traumatic intracranial aneurysm following blunt head injury is uncommon but can be induced by extension of skull base fracture and causes unexpected hemorrhagic complications. We present two cases of traumatic intracranial aneurysm in the paraclinoid area that was revealed by delayed massive epistaxis. Lack of initial neurological deficits omitted screening for cerebrovascular injury. Outcome Internal trapping was carried out using endovascular techniques in both cases, with extracranial-intracranial bypass in one case. No recurrent bleeding occurred in either case. Conclusion To prevent unexpected delayed life-threatening hemorrhagic accidents, careful assessment of skull-base fracture is prerequisite, even in cases of mild facial injury.
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Affiliation(s)
- Hajime Nakamura
- Department of NeurosurgeryOsaka University Graduate School of MedicineOsakaJapan
| | | | - Osamu Tasaki
- Department of Emergency MedicineUnit of Clinical MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Toshiki Yoshimine
- Division of Clinical NeuroengineeringGlobal Center for Medical Engineering and InformaticsOsaka UniversityOsakaJapan
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Paraskevas K, Batchelder A, Naylor A. Fate of Distal False Aneurysms Complicating Internal Carotid Artery Dissection: A Systematic Review. Eur J Vasc Endovasc Surg 2016; 52:281-6. [DOI: 10.1016/j.ejvs.2016.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 03/17/2016] [Indexed: 11/24/2022]
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Alderazi YJ, Cruz GM, Kass-Hout T, Prestigiacomo CJ, Duffis EJ, Gandhi CD. Endovascular therapy for cerebrovascular injuries after head and neck trauma. TRAUMA-ENGLAND 2015. [DOI: 10.1177/1460408615573884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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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Affiliation(s)
- Yazan J Alderazi
- Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Ghislaine M Cruz
- Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Tareq Kass-Hout
- Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Charles J Prestigiacomo
- Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - E Jesus Duffis
- Neurointerventional Surgery, Department of Neurology, Baystate Medical Center, Springfield, MA, USA
| | - Chirag D Gandhi
- Endovascular Neurosurgery, Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
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Pan YH, Lin Y, Ding SH, Chen L, Liang YM, Yin YH, Bao YH, Gao GY, Qiu YM, Jiang JY. Endovascular treatment of the extracranial carotid pseudoaneurysms resulting from stab penetrating injury using overlapping bare stents. Vasc Endovascular Surg 2014; 48:337-41. [PMID: 24476789 DOI: 10.1177/1538574413518613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Injury pertaining to the common carotid artery may result in complete or partial arterial transection, pseudoaneurysms, or arteriovenous connections. Endovascular treatment option of the pseudoaneurysm has already been established with favorable success rate and minimal morbidity. Our purpose is to report one 18-year-old male patient having 2 traumatic pseudoaneurysms as a result of penetrating stab injury in the extracranial common carotid. The patient was successfully treated using 2 overlapping bare-metal stents. The 2 common carotid pseudoaneurysms had different degree inflow angles defined as the space between the lines indicating the direction of blood flow from the parent artery and through the aneurysmal neck to the dome. Computed tomography angiography was utilized to follow the evolution of the pseudoaneurysms until total occlusion was demonstrated. The treatment modality used in this report represents an alternative approach of the endovascular treatment for the extracranial carotid pseudoaneurysm.
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Affiliation(s)
- Yao-hua Pan
- Department of Neurological Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Rouchaud A, Klein I, Amarenco P, Mazighi M, Pacchioni A, Torsello G, Reimers B, van Sambeek MRHM, Tielbeek AV, Teijink JAW, Cuypers PW. How should I treat a symptomatic post dissection carotid aneurysm? EUROINTERVENTION 2014; 9:1121-3. [PMID: 24457283 DOI: 10.4244/eijv9i9a187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Aymeric Rouchaud
- INSERM U-698 and Denis Diderot University-Paris VII, Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France
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