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Imamoto T, Sawano M, Murase M, Yasuda S, Yahata T. Massive Hemorrhage Associated With Upper Cervical Vertebral Fracture Treated Successfully With Transcatheter Arterial Embolization: A Case Report. Cureus 2024; 16:e51826. [PMID: 38327908 PMCID: PMC10847713 DOI: 10.7759/cureus.51826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/09/2024] Open
Abstract
Blunt vertebral artery injuries (BVAI) associated with cervical spine fractures are often problematic due to symptoms of occlusion. Denver grade V cases, in which the vertebral artery is transected, are rare but often fatal, and treatment has rarely been reported. We encountered a case of hemorrhagic shock due to an injury to a branch of the vertebral artery associated with an upper cervical spine fracture. Transcatheter arterial embolization was performed successfully to achieve hemostasis, requiring superselective arterial embolization to preserve the main trunk of the vertebral artery. It is important to be aware that vascular injuries to the branch vessels as well as the main trunk can cause complications.
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Affiliation(s)
- Toshiro Imamoto
- Department of Emergency Medicine and Critical Care, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Makoto Sawano
- Department of Emergency Medicine and Critical Care, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Makoto Murase
- Department of Emergency Medicine and Critical Care, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Shinichi Yasuda
- Department of Emergency Medicine and Critical Care, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
| | - Tadashi Yahata
- Department of Emergency Medicine and Critical Care, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
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2
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Akinnusotu O, Bhatti AUR, Ghaith AK, Nieves AB, Jarrah R, Wahood W, Bydon M, Bendok BR. Outcomes following surgical and endovascular treatment of extracranial vertebral artery aneurysms (VAA): a systematic evaluation of the literature. Neurosurg Rev 2023; 46:260. [PMID: 37779135 DOI: 10.1007/s10143-023-02171-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/06/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
Extracranial vertebral artery aneurysms are rare complications resulting from trauma and multiple different diseases. However, the difference between clinical and surgical profiles is well understood. To investigate the clinical and interventional outcomes following extracranial vertebral artery aneurysms (VAA) treatment through a systematic review of the literature to date, an electronic database search for full-text English articles was conducted following PRISMA guidelines. The search yielded results on clinical and surgical outcomes for extracranial VAAs. These results included patient-specific risk factors, indications, and techniques. Our literature search resulted in 561 articles, of which 36 studies were qualified to be included in the analysis. A total of 55 patients with multiple various extracranial VAA incidents were included. The mean age of subjects was 42 years (ranging from 13.0 to 76.0 years), and the majority of patients were males (71%, n =39). Blunt trauma was the most frequent risk factor for extracranial VAA formation (35%, n = 19). The majority of aneurysms (60%) were dissected in nature. The most common form of treatment for extracranial VAAs was the use of a flow diverter (24%, n=13). Overall, five (9%) patients had long-term adverse neurological complications following intervention with 5% (n=3) mortality, 2% (n=1) resulting in unilateral vocal cord paralysis, and 2% (n=1) resulted in a positive Romberg sign. The mortality rate is 15.7% in the surgical group, whereas the endovascular treatment did not result in any mortality. The endovascular approach is a safe and effective treatment of extracranial VAAs due to its relatively low overall complication rate and lack of resulting mortality. This is in contrast to the surgical approach which results in a higher rate of complications, recurrence, and mortality outcomes. An understanding of the factors and clinical outcomes associated with the incidence of extracranial VAAs is essential for the future improvement of patient outcomes.
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Affiliation(s)
| | - Atiq Ur Rehman Bhatti
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Abdul Karim Ghaith
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Antonio Bon Nieves
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ryan Jarrah
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Waseem Wahood
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, FL, 33328, USA
| | - Mohamad Bydon
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, USA
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3
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Wu M, Tay J, Lloyd D. Management of a penetrating vertebral artery injury in a peripheral hospital. TRAUMA-ENGLAND 2023. [DOI: 10.1177/14604086231160299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Vertebral artery (VA) injuries in penetrating trauma are rare but can be life threatening. Management is often reliant on interventional radiology (IR), although such services may be lacking in peripheral centres. We report a case of a 22-year-old man who sustained a right VA injury from a stab wound to the posterolateral neck that was managed in a rural hospital. On presentation, the patient was initially haemodynamically stable but began exsanguinating heavily whilst undergoing imaging and was subsequently transferred to the operating theatre. Intraoperatively, bleeding was noted from the C5/C6 interforaminal space. Due to difficulty with exposure and lack of specialist surgical services, bimanual pressure was continuously applied to the wound whilst awaiting the arrival of a vascular surgeon and neuro-interventionalist who were transported by air from a tertiary hospital. At the time of angiography, bleeding had ceased and no further intervention was required. This case highlights the importance for surgeons in peripheral centres to be aware of some of the operative manouvres used in managing VA injuries including the utility of continued direct pressure. Moreover, it serves as a reminder that there remains a role for operative intervention in the unstable patient despite increasing reliance on radiological techniques to treat such injuries.
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Affiliation(s)
- Michael Wu
- Department of General Surgery, Launceston General Hospital, Launceston, Australia
| | - Jia Tay
- Department of General Surgery, Launceston General Hospital, Launceston, Australia
| | - David Lloyd
- Department of General Surgery, Launceston General Hospital, Launceston, Australia
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4
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Endovascular and Antithrombotic Treatment in Blunt Cerebrovascular Injuries: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2022; 31:106456. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/22/2022] Open
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5
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Jiang Y, Di R, Lu G, Huang L, Wan H, Ge L, Zhang X. Long-Term Outcomes of Stenting on Non-Acute Phase Extracranial Supra-Aortic Dissections. J Korean Neurosurg Soc 2022; 65:422-429. [PMID: 35462523 PMCID: PMC9082125 DOI: 10.3340/jkns.2021.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022] Open
Abstract
Objective Methods Results Conclusion
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6
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Ichibayashi R, Suzuki G, Nakamichi Y, Yamamoto S, Serizawa H, Watanabe M, Harada M, Harada N, Honda M. Penetrating vertebral artery injury treated by combining the "zone" approach and imaging tests: A case report. Clin Case Rep 2021; 9:e05134. [PMID: 34849232 PMCID: PMC8609188 DOI: 10.1002/ccr3.5134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
Patients with vertebral artery injury from penetrating neck trauma may not present with signs of vascular injury because of anatomical characteristics and concomitant conditions, such as hypothermia and shock. If patients are hemodynamically stable, imaging tests should be performed to examine the posterior components, including the vertebral artery.
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Affiliation(s)
- Ryo Ichibayashi
- Department of Critical Care CenterToho University Medical Center Omori HospitalOta‐kuJapan
| | - Ginga Suzuki
- Department of Critical Care CenterToho University Medical Center Omori HospitalOta‐kuJapan
| | - Yoshimi Nakamichi
- Department of Critical Care CenterToho University Medical Center Omori HospitalOta‐kuJapan
| | - Saki Yamamoto
- Department of Critical Care CenterToho University Medical Center Omori HospitalOta‐kuJapan
| | - Hibiki Serizawa
- Department of Critical Care CenterToho University Medical Center Omori HospitalOta‐kuJapan
| | - Masayuki Watanabe
- Department of Critical Care CenterToho University Medical Center Omori HospitalOta‐kuJapan
| | - Masashi Harada
- Department of NeurosurgeryToho University Medical Center Omori HospitalOta‐kuJapan
| | - Naoyuki Harada
- Department of NeurosurgeryToho University Medical Center Omori HospitalOta‐kuJapan
| | - Mitsuru Honda
- Department of Critical Care CenterToho University Medical Center Omori HospitalOta‐kuJapan
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7
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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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8
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Glaser JD, Kalapatapu VR. Endovascular Therapy of Vascular Trauma—Current Options and Review of the Literature. Vasc Endovascular Surg 2019; 53:477-487. [DOI: 10.1177/1538574419844073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: To review the current use of endovascular techniques in trauma. Summary Background Data: Multiple studies have demonstrated that, despite current guidelines, endovascular therapies are used in instances of arterial trauma. Methods: The existing literature concerning arterial trauma was reviewed. Studies reviewed included case reports, single-center case series, large database studies, official industry publications and instructions for use, and society guidelines. Results: Endovascular therapies are used in arterial trauma in all systems. The use of thoracic endografts in blunt thoracic aortic trauma is accepted and endorsed by society guidelines. The use of endovascular therapies in other anatomic locations is largely limited to single-center studies. Advantages potentially include less morbidity due to smaller incisions as well as shorter operating room times. Many report using endovascular therapies even with hard signs of injury. Long-term results are limited by a lack of long-term follow-up but, in general, suggest that these techniques produce acceptable outcomes. The adoption of these techniques may be limited by resource and surgeon availability. Conclusions: The use of endovascular therapies in trauma has gained acceptance despite not yet having a place in official guidelines.
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Affiliation(s)
- Julia D. Glaser
- Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Venkat R. Kalapatapu
- Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, PA, USA
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9
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Yuk-Yu L, Hon-For T, Hok-Leung W, Yuk-Yin C. Management Approach of Penetrating Vertebral Artery Injury with Concomitant Cervical Nerve Root Injury in Regional Hospital: Report of Two Cases. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2018. [DOI: 10.1016/j.jotr.2017.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Penetrating vertebral artery injury is uncommon yet potentially fatal. We present two cases of penetrating vertebral artery injury with concomitant cervical nerve root injury managed in our centre. The first case was a young gentleman who suffered from neck injury by broken metal fragment. Cervical nerve root injury was suspected preoperatively. Massive bleeding from vertebral artery was encountered during wound exploration. It was managed by ligation, followed by retrograde endovascular embolisation. The second case was a young lady being assaulted with knife and fork over the neck. She was also suspected to have cervical nerve root injury preoperatively. Vascular control of vertebral artery was achieved with endovascular intervention. Subsequent operation for foreign body removal and nerve root repair was performed with minimal bleeding intraoperatively. Management approach of penetrating vertebral artery injury with concomitant cervical nerve root injury and the role of endovascular intervention were discussed.
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Affiliation(s)
- Lam Yuk-Yu
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Tsui Hon-For
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Wong Hok-Leung
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Chow Yuk-Yin
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, Hong Kong
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10
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TO THE EDITOR. Spine (Phila Pa 1976) 2018; 43:E320. [PMID: 29432409 DOI: 10.1097/brs.0000000000002530] [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: 02/05/2023]
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11
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Yaeger K, Mascitelli J, Kellner C, Hickman Z, Mocco J, Margetis K. Temporary vertebral artery occlusion after C3 fracture dislocation injury and spontaneous resolution following reduction and instrumented fusion: case report and literature review. J Neurointerv Surg 2016; 9:1027-1030. [PMID: 27798854 DOI: 10.1136/neurintsurg-2016-012671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/08/2016] [Accepted: 09/15/2016] [Indexed: 11/03/2022]
Abstract
Vertebral artery injuries as a result of blunt trauma can result in vertebrobasilar strokes. Typical treatment of such an injury includes early anticoagulation to prevent cerebral ischemic events due to vessel occlusion or embolism. We present a case of cervical fracture-dislocation injury and compression/occlusion of the right vertebral artery, which spontaneously resolved following surgical reduction and fusion. Postoperative cerebral angiography showed no evidence of vertebral artery stenosis, and systemic anticoagulation was discontinued. This case shows that vertebral artery occlusion can resolve spontaneously after fracture reduction, and cerebral angiography should play a role in assessing these complicated traumatic injuries.
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Affiliation(s)
- Kurt Yaeger
- Department of Neurological Surgery, Cerebrovascular Center, Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA
| | - Justin Mascitelli
- Department of Neurological Surgery, Cerebrovascular Center, Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA
| | - Christopher Kellner
- Department of Neurological Surgery, Cerebrovascular Center, Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA
| | - Zachary Hickman
- Department of Neurological Surgery, Elmhurst Hospital Trauma Center, Mount Sinai Medical System, New York, New York, USA
| | - J Mocco
- Department of Neurological Surgery, Cerebrovascular Center, Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA
| | - Konstantinos Margetis
- Department of Neurological Surgery, Cerebrovascular Center, Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA.,Department of Neurological Surgery, Elmhurst Hospital Trauma Center, Mount Sinai Medical System, New York, New York, USA
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12
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Zhou B, Alshareef M, Prim D, Collins M, Kempner M, Hartstone-Rose A, Eberth JF, Rachev A, Shazly T. The perivascular environment along the vertebral artery governs segment-specific structural and mechanical properties. Acta Biomater 2016; 45:286-295. [PMID: 27612958 DOI: 10.1016/j.actbio.2016.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/30/2016] [Accepted: 09/01/2016] [Indexed: 01/05/2023]
Abstract
The vertebral arteries (VAs) are anatomically divided into four segments (V1-V4), which cumulatively transport blood flow through neck and ultimately form the posterior circulation of the brain. The vital physiological function of these conduit vessels depends on their geometry, composition and mechanical properties, all of which may vary among the defined arterial segments. Despite their significant role in blood circulation and susceptibility to injury, few studies have focused on characterizing the mechanical properties of VAs, and none have investigated the potential for segmental variation that could arise due to distinct perivascular environments. In this study, we compare the passive mechanical response of the central, juxtaposed arterial segments of porcine VAs (V2 and V3) via inflation-extension mechanical testing. Obtained experimental data and histological measures of arterial wall composition were used to adjust parameters of structure-motivated constitutive models that quantify the passive mechanical properties of each arterial segment and enable prediction of wall stress distributions under physiologic loads and boundary conditions. Our findings reveal significant segmental differences in the arterial wall geometry and structure. Nevertheless, similar wall stress distributions are predicted in these neighboring arterial segments if calculations account for their specific perivascular environments. These findings allow speculation that segmental differences in wall structure and geometry are a consequence of a previously introduced principle of optimal operation of arteries, which ensures effective bearing of physiological load and a favorable mechanical environment for mechanosensitive vascular smooth muscle cells. STATEMENT OF SIGNIFICANCE Among the numerous biomechanical investigations devoted to conduit blood vessels, only a few deal with vertebral arteries. While these studies provide useful information that describes the vessel mechanical response, they do not enable identification of a constitutive formulation of the mechanical properties of the vessel wall. This is an important distinction, as a constitutive material model is required to calculate the local stress environment of mechanosensitive vascular cells and fully understand the mechanical implications of both vascular injury and clinical intervention. Moreover, segmental differences in the mechanical properties of the vertebral arteries could be used to discriminate among distinct modes of injury and disease etiologies.
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13
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Uchikawa H, Kai Y, Ohmori Y, Kuratsu JI. Strategy for endovascular coil embolization of a penetrating vertebral artery injury. Surg Neurol Int 2015; 6:117. [PMID: 26229732 PMCID: PMC4513296 DOI: 10.4103/2152-7806.160320] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/05/2015] [Indexed: 11/04/2022] Open
Abstract
Background: Penetrating vertebral artery injuries (VAIs) are even rarer than carotid artery injuries. For anatomical reasons, the surgical management of VAI is difficult, and endovascular management often yields a good outcome. We report our strategy for the endovascular treatment of a patient with a penetrating VAI at the V2 segment of the left vertebral artery. Case Description: In a fall on a large rake, a 76-year-old man was stabbed in the left neck by three tines. Although he manifested no neurological deficits, computed tomography (CT) suggested penetrating VAI. Digital subtraction angiography confirmed VAI and extravasation, and he underwent endovascular coil embolization. Two microcatheters, inserted proximal and distal to the injury sites, were used for successful endovascular coil embolization. Postoperative magnetic resonance imaging - and single photon emission CT studies denied cerebral infarction and a decrease in cerebral perfusion. The patient exhibited no neurological deficits and was able to leave the hospital on foot. Conclusion: This is the rare documentation of a patient whose penetrating VAI was treated by simultaneous coil embolization and foreign body removal. Imaging studies confirmed the patency and perfusion of the intracranial artery. Our treatment strategy produced a good outcome in this unusual patient.
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Affiliation(s)
- Hiroki Uchikawa
- Department of Neurosurgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Yutaka Kai
- Department of Neurosurgery, School of Medicine, Kumamoto University, Kumamoto, Japan
| | - Yuki Ohmori
- Department of Neurosurgery, School of Medicine, Kumamoto University, Kumamoto, Japan
| | - Jun-Ichi Kuratsu
- Department of Neurosurgery, School of Medicine, Kumamoto University, Kumamoto, Japan
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14
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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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15
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Individualized endovascular treatment of high-grade traumatic vertebral artery injury. Acta Neurochir (Wien) 2014; 156:1781-8. [PMID: 24781679 DOI: 10.1007/s00701-014-2074-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/19/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Traumatic vertebral artery injury (TVAI) is associated with craniocervical trauma that can lead to potentially fatal posterior circulation stroke. It presents a clinical challenge since it is hard to detect and there are no widely accepted guidelines on diagnosis and management. High-grade TVAI is more difficult to treat and no consensus has been reached yet. METHODS We performed a single-center, long-term, therapeutic study involving 272 patients with craniocervical injury, eleven of which were diagnosed with high-grade TVAI. Individualized endovascular treatments were performed on these patients based upon the hemodynamic and morphological characteristics of the injured vertebral artery. Postoperative angiography was conducted at 2 weeks, 3 months and 6 months, and then annually after intervention. RESULTS Ten vertebral pseudoaneurysms and one arteriovenous fistula (AVF) were confirmed by postoperative angiography. All the participants' neurological deficit symptoms disappeared or were significantly alleviated gradually, and no new symptoms were found after endovascular treatment. Follow-up angiography of the patients with pseudoaneurysms showed a normally shaped vertebral artery with no stenosis or aneurysms; the angiographic result of the patient with the AVF presented successful embolization in the proximal vertebral artery fistula with no progression or new stenosis. Their modified Rankin Scale (mRS) scores were also satisfactory. CONCLUSIONS Application of individualized endovascular therapy in high-grade TVAI is safe, technically feasible and clinically effective, but there is no comparison between endovascular management and other management approaches because randomized trials cannot be carried out currently.
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16
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de Castro SM, Christiaans SC, van den Berg R, Schep NW. Minimal invasive management of traumatic transection of the vertebral artery. SPRINGERPLUS 2014; 3:206. [PMID: 24809004 PMCID: PMC4012030 DOI: 10.1186/2193-1801-3-206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 04/14/2014] [Indexed: 11/21/2022]
Abstract
Stab wounds to the neck can be potentially lethal. They are often associated with vascular injury of the carotid artery and jugular vein. Injury of the vertebral artery is rarely seen. The injury can vary from severe bleeding after transection with hemorrhage into the surrounding soft tissues of the neck to dissection and separation of the intimal lining from the subjacent media of an artery and subsequent occlusion of the vessel. We report a case of traumatic vertebral artery transection managed by minimal invasive balloon occlusion.
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Affiliation(s)
- Steve Mm de Castro
- Department of Traumatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sarah C Christiaans
- Department of Traumatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rene van den Berg
- Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Niels Wl Schep
- Department of Traumatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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17
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Clinical outcomes of patients with vertebral artery dissection treated endovascularly: a meta-analysis. Neurosurg Rev 2014; 37:569-77. [DOI: 10.1007/s10143-014-0541-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/08/2014] [Indexed: 11/25/2022]
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18
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Harrigan MR, Hadley MN, Dhall SS, Walters BC, Aarabi B, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Theodore N. Management of Vertebral Artery Injuries Following Non-Penetrating Cervical Trauma. Neurosurgery 2013; 72 Suppl 2:234-43. [DOI: 10.1227/neu.0b013e31827765f5] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mark R. Harrigan
- Division of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark N. Hadley
- Division of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sanjay S. Dhall
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Beverly C. Walters
- Division of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Neurosciences, Inova Health System, Falls Church, Virginia
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland
| | - Daniel E. Gelb
- Department of Orthopaedics, University of Maryland, Baltimore, Maryland
| | - R. John Hurlbert
- Department of Clinical Neurosciences, University of Calgary Spine Program, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Curtis J. Rozzelle
- Division of Neurological Surgery, Children's Hospital of Alabama University of Alabama at Birmingham, Birmingham, Alabama
| | - Timothy C. Ryken
- Iowa Spine & Brain Institute, University of Iowa, Waterloo/Iowa City, Iowa
| | - Nicholas Theodore
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
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Desouza RM, Crocker MJ, Haliasos N, Rennie A, Saxena A. Blunt traumatic vertebral artery injury: a clinical review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:1405-16. [PMID: 21674212 DOI: 10.1007/s00586-011-1862-y] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 05/22/2011] [Accepted: 05/22/2011] [Indexed: 11/25/2022]
Abstract
Blunt traumatic vertebral injury (TVAI) is frequently associated with head and neck injury and is being detected with increasing frequency due to improved imaging of the trauma patient. In a few cases, it can lead to potentially fatal posterior circulation ischaemia There is debate in the literature regarding whether TVAI should be actively screened for and, if so, how. Management of TVAI may be conservative, medical (antiplatelet agents or anticoagulation), endovascular or open surgery. We review the literature concerning the mechanisms and presentation of TVAI following blunt injury and the current screening recommendations. Management strategies proposed are based on the radiological grade and clinical severity of TVAI, where high-grade symptomatic injuries and high-grade injuries in patients where anticoagulation is contraindicated are treated endovascularly and asymptomatic or low-grade injuries are managed with anticoagulation where it is not contraindicated. Follow-up is via CT angiography to assess for resolution of the injury.
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Affiliation(s)
- R M Desouza
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
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Pham MH, Rahme RJ, Arnaout O, Hurley MC, Bernstein RA, Batjer HH, Bendok BR. Endovascular Stenting of Extracranial Carotid and Vertebral Artery Dissections: A Systematic Review of the Literature. Neurosurgery 2011; 68:856-66; discussion 866. [DOI: 10.1227/neu.0b013e318209ce03] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Abstract
BACKGROUND:
Carotid and vertebral artery dissections are a leading cause of stroke in young individuals.
OBJECTIVE:
To examine the published safety and efficacy of endovascular stenting for extracranial artery dissection.
METHODS:
We conducted a systematic review of the literature to identify all cases of endovascular management of extracranial carotid and vertebral artery dissections.
RESULTS:
For carotid dissections, our review yielded 31 published reports including 140 patients (153 vessels). Reported etiologies were traumatic (48%, n = 64), spontaneous (37%, n = 49), and iatrogenic (16%, n = 21). The technical success rate of stenting was 99%, and the procedural complication rate was 1.3%. Mean angiographic follow-up was 12.8 months (range, 2-72 months) and revealed in-stent stenosis or occlusion in 2% of patients. Mean clinical follow-up was 17.7 months (range, 1-72 months), and neurological events were seen in 1.4% of patients. For vertebral artery dissections, our review revealed 8 reports including 10 patients (12 vessels). Etiologies were traumatic (60%, n = 6), spontaneous (20%, n = 2), and iatrogenic (20%, n = 2). There was a 100% technical success rate. The mean angiographic follow-up period was 7.5 months (range, 2-12 months). No new neurological events were reported during a mean clinical follow-up period of 26.4 months (range, 3-55 months).
CONCLUSION:
Endovascular management of extracranial arterial dissection continues to evolve. Current experience shows that this treatment option is safe and technically feasible. Prospective randomized trials compared with medical management are needed to further elucidate the role of stenting.
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Affiliation(s)
- Martin H. Pham
- Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| | - Rudy J. Rahme
- Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| | - Omar Arnaout
- Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| | - Michael C. Hurley
- Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| | - Richard A. Bernstein
- Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| | - H. Hunt Batjer
- Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
| | - Bernard R. Bendok
- Departments of *Neurological Surgery, ‡Radiology, and §Neurology, Northwestern University Feinberg School of Medicine and McGaw Medical Center, Chicago, Illinois
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Haller W, Vrazas J, Bekhit E, Hardikar W. Voice matters: late presentation of an iatrogenic vertebral arteriovenous fistula after liver transplantation in early childhood with successful endovascular treatment. Cardiovasc Intervent Radiol 2011; 34:1109-12. [PMID: 21301844 DOI: 10.1007/s00270-011-0107-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 01/10/2011] [Indexed: 11/25/2022]
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Kalish J. Selective Use of Endovascular Techniques in the Management of Vascular Trauma. Semin Vasc Surg 2010; 23:243-8. [DOI: 10.1053/j.semvascsurg.2010.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Munera F, Danton G, Rivas LA, Henry RP, Ferrari MG. Multidetector row computed tomography in the management of penetrating neck injuries. Semin Ultrasound CT MR 2009; 30:195-204. [PMID: 19537052 DOI: 10.1053/j.sult.2009.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Penetrating neck trauma may occur from gun shots, stabbings, and accidental injury. Approximately 50% of gunshot and 10%-20% of stab-wound patients are reported as having severe injuries and the mortality from severe vascular injuries is reported as high as 50%. Penetrating traumatic neck injury is no longer best managed with exploratory surgery or conventional angiography in the stable patient. Computed tomography angiography has proven to be a useful, safe, and reliable means of diagnosis. Experience with interpreting and reconstructing computed tomography images, understanding the clinically important findings, and avoiding pitfalls is critical for successful patient care. Therefore, radiologists and clinicians who treat trauma patients need to familiarize themselves with the computed tomography angiography technique and appearances of vascular injury and know when to recommend further evaluation, such as interventional angiography or open surgery.
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Affiliation(s)
- Felipe Munera
- Department of Radiology, Jackson Memorial Hospital/Ryder Trauma Center, University of Miami, Miller School of Medicine, 1611 NW 12th Avenue, Miami, FL 33136, USA.
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Sliker CW. Blunt Cerebrovascular Injuries: Imaging with Multidetector CT Angiography. Radiographics 2008; 28:1689-708; discussion 1709-10. [DOI: 10.1148/rg.286085521] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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