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Endovascular reconstruction of extracranial traumatic internal carotid artery dissections: a systematic review

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Abstract

Extracranial internal carotid artery dissection (ICAD) is a potential source of morbidity and mortality in trauma patients and requires high degree of suspicion for diagnosis after the initial presentation. Occasionally, if standard therapy is contraindicated, endovascular reconstruction is a treatment option. The aim of this systematic review was to report clinical and radiographic outcomes following endovascular repair of ICAD of traumatic and iatrogenic etiology. A comprehensive systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed and Cochrane Library databases were searched. Twenty-four studies comprising 191 patients (204 lesions) were included; 179 underwent traditional carotid artery stenting (CAS), whereas 12 patients underwent flow diversion with the pipeline embolization device (PED). In total, 75.7% of the CAS group and 66.6% of the PED group presented with ICAD-related symptomatology. Concomitant pseudoaneurysms were identified in 61.9% and 78.5% of lesions in the CAS and PED group, respectively. Adverse event rates among CAS-treated lesions after 30-day follow-up were below 2.2% for stroke, transient ischemic attack, and mortality. During follow-up in the CAS group, there was no incidence of ICAD-related stroke or death and 2.2% of patients underwent a repeat CAS procedure. In the PED group, no patient suffered stroke or death in the reported follow-up. In the PED cohort, there was an adequate occlusion rate and no patient had to be retreated. Endovascular reconstruction of traumatic or iatrogenic ICAD appears safe. This approach demonstrated acceptable short- and long-term clinical and radiographic outcomes in both groups.

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Authors and Affiliations

  1. Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA

    Pavlos Texakalidis

  2. Medical School Aristotle University of Thessaloniki, Thessaloniki, Greece

    Theofilos Karasavvidis & Andreas Tzoumas

  3. 251 HAF and VA Hospital, Athens, Greece

    Stefanos Giannopoulos

  4. Department of Surgery, Stony Brook University Stony Brook, NY, USA

    Nektarios Charisis

  5. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

    Pascal Jabbour

  6. Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA

    Theofilos Machinis & John Reavey-Cantwell

  7. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA

    Leonardo Rangel-Castilla

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Texakalidis, P., Karasavvidis, T., Giannopoulos, S. et al. Endovascular reconstruction of extracranial traumatic internal carotid artery dissections: a systematic review. Neurosurg Rev 43, 931–940 (2020). https://doi.org/10.1007/s10143-019-01092-6

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