Endovascular Repair of Traumatic Cervical Internal Carotid Artery Injuries: A Safe and Effective Treatment Option

BACKGROUND AND PURPOSE: The appropriate choice of treatment for traumatic extracranial carotid artery injury is still debated. The purpose of this study was to evaluate outcomes of endovascular carotid repair with regard to vessel patency and retreatment rates.

METHODS AND METHODS: We retrospectively reviewed records of patients who underwent endovascular treatment for acute traumatic internal carotid artery dissection with or without pseudoaneurysm formation. The Biffl classification of blunt carotid arterial injuries with an additional modification to stratify grade 2 and 3 injuries into no-flow-limiting (2a/3a) and flow-limiting (2b/3b) was used to classify injuries.

RESULTS: Forty-seven patients underwent 50 endovascular interventions. Forty-four were treated with stents alone, 4 required both stent and coil treatments, and 2 were treated with coils alone. Initial treatment resulted in complete restoration of the normal vessel lumen diameter in 25 (50%) treated vessels and good-to-acceptable restoration in 25 (50%) vessels. A single patient had complete stent occlusion. Three patients required stent and/or coil retreatment. There was no mortality or permanent morbidity relating to endovascular carotid artery repair. Twenty-one patients initially treated with medical management ultimately required endovascular treatment. Eighteen (87.5%) of these injuries were initially classified as grade 3a and 3 (14.3%) were initially grade 2a. Injury progression necessitating treatment was identified, on average, within 5 weeks of the initial injury.

CONCLUSIONS: In our series, endovascular therapy was a safe and effective option for restoring luminal caliber and eliminating flow within pseudoaneurysms related to traumatic injuries. Imaging follow-up of all cervicocerebral vascular injuries is especially important within the first 45 days, a critical interval during which most lesions demonstrate healing or progression.