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Management of traumatic carotid artery dissection: initial experience of a single center

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Abstract

Traumatic carotid artery dissection (tCAD) bears the risk of hypoperfusion inducing delayed cerebral ischemia. The lack of consensus on standard treatment of tCAD remains a great challenge. Here, we present our successes on a series of patients with delayed tCAD diagnosis and treatment using multimodality treatment strategies. We retrospectively reviewed 21 patients with tCAD treated with carotid artery stent placement or anticoagulation therapy. There were 14 dissection locations (66.67 %) which involved extracranial internal carotid artery (ICA) and seven locations (33.33 %) which involved both extracranial and intracranial ICA. Stenosis severity was 70–99 % in 16 cases (76.19 %) and <70 % in 5 cases (23.81 %). Endovascular stents were administrated to 17 patients with hypoperfusion as evaluated by radiological methods, while anticoagulation therapy was administrated to the other four patients. Carotid revascularization was performed with one (9/17 patients) or multiple (8/17 patients) stents. None of the patients experienced a procedure-related complication. At discharge, the mean modified Rankin Scale (mRS) score of patients was 1.08 ± 0.76. Neither additional neurological deficient nor restenosis happened during the follow-up period. More vigilance is required to assure timely diagnosis of patients with delayed tCAD. Assessment of cerebral perfusion is an effective approach in tCAD treatment in our experience.

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197, Rui Jin Er Road, Shanghai, 200025, China

    Xie Zhengxing, Cui Zhenwen, Sun Yuhao, Zhong Zhihong, Bian Liuguan & Sun Qingfang

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  1. Xie Zhengxing
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  2. Cui Zhenwen
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  3. Sun Yuhao
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  4. Zhong Zhihong
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  5. Bian Liuguan
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  6. Sun Qingfang
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Corresponding author

Correspondence to Bian Liuguan.

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Comments

Daphne D. Li and Christopher M. Loftus, Maywood, USA

The authors of this article conducted a retrospective review of treatment and management of 21 patients with traumatic carotid artery dissection (tCAD). tCAD is a leading cause of stroke in young people, but there is a lack of consensus regarding a standard of treatment. In addition, the authors believe that tCAD warrants alternative strategies of treatment, as opposed to spontaneous CAD, because of inadequate response to conservative therapy and increased vulnerability to ischemic secondary to traumatic injury. The authors of this retrospective study hope to provide some insight into guiding management.

The authors of this study review the diagnosis and treatment algorithm for patients with traumatic injury and a high suspicion for tCAD. Initial evaluation with CTA/MRA and subsequent diagnosis and/or treatment through formal angiography resulted in good outcomes and zero complications for the patients included in this study.

Based on their experience, the authors conclude that assessment of cerebral perfusion may be an effective approach to guiding tCAD. As well, vigilance is key in assuring timely diagnosis, as tCAD may make a delayed appearance in a patient’s hospital course or symptoms may be masked by coexisting traumatic injuries. They also identify patients with injuries involving sudden neck movements and cervical spine or skull base fractures as high-risk patients.

The authors present a retrospective study on a small sample size of patients in an effort to optimize management of tCAD. Follow-up length was limited to 72 months at most, with 43 months on average. No patients had complete carotid occlusion. The aforementioned are limitations that prevent us from making generalized conclusions regarding tCAD management and applying it to all patients with carotid stenosis. Future investigations may be better guided in their study design, with a larger sample size and longer follow-up in order to contribute to the growing body of literature on optimal AVM management.

Tamer Hassan, Alexandria, Egypt

Zhengxing et al. have discussed very important category of cerebrovascular diseases namely TCAD that still lack consensus of appropriate clear treatment methodology. Although 21 patients are few number to have solid conclusion, still the authors combine the use of perfusion and angiographic studies to make the appropriate judgment of treatment methodology in a very wise and logic way. The combination of different treatment methodology options also like anticoagulation therapy, bypass surgery, and endovascular stenting in the same neurosurgery department hit the ring of important message that they offer all possible options for patient care for patients’ own sake in the same department. I believe that the paper is interesting to read and congratulate the group for their work.

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Zhengxing, X., Zhenwen, C., Yuhao, S. et al. Management of traumatic carotid artery dissection: initial experience of a single center. Neurosurg Rev 39, 393–399 (2016). https://doi.org/10.1007/s10143-015-0689-0

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  • DOI: https://doi.org/10.1007/s10143-015-0689-0

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