Shmuel Y. Mahgerefteh MD, Presenter: Nothing to Disclose

Samuel Moscovici MD, Abstract Co-Author: Nothing to Disclose

Fernando Ramirez-de-Noriega, Abstract Co-Author: Nothing to Disclose

Iddo Paldor, Abstract Co-Author: Nothing to Disclose

Nurith H. Bedussa, Abstract Co-Author: Nothing to Disclose

Eyal Itshayek MD, Abstract Co-Author: Nothing to Disclose

John Moshe Gomori MD, Abstract Co-Author: Research Consultant, Medic Vision Ltd Research Consultant, BrainWatch Ltd Research Consultant, Medtronic, Inc

Jose Enrique Cohen MD, Abstract Co-Author: Nothing to Disclose

To evaluate the technical feasibility, safety, and neurovascular outcomes of endovascular stenting in the management of traumatic extracranial carotid or vertebral artery dissection in patients for whom anticoagulation is contraindicated or has failed.

We reviewed all cases of traumatic carotid or vertebral artery dissection that were treated at our institution with endovascular stenting, and recorded details of medical/surgical background, clinical/neurological presentation, imaging and endovascular findings, as well as follow-up encounters.

From 2003 until the present, 23 patients (M:F=19:4; ages 14-66 years, median 43) admitted to our institution with traumatic extracranial internal carotid artery (ICA, 21 patients) or vertebral artery dissection (2 patients) were treated with stent-assisted angioplasty. The mechanism of injury was multiple trauma in 14 (6.1%), including motor vehicle accident in 9, fall from a height in 4, bicycle accident in 1; minor cranial-cervical injury in 7 (30.4%), and penetrating cervical injury in 2 (8.7%). 14 patients (6.1%) presented with ischemic stroke, 3 (13.0%) with transient ischemic attack, 2 (8.7%) were diagnosed at screening for penetrating injury, 1 (4.3%) at CT in a comatose patient, 1 (4.3%) due to Horner syndrome. Indications for angioplasty were contraindication to anticoagulation in 14 (6.1%), failure of anticoagulation in 6 (26.1%), and impending stroke in 13 (56.5%). 39 stents were required; 11 patients received multiple stents. Mean stenosis was 62% before angioplasty (range 10-100%) and 5% (range 0-20%) after endovascular intervention. There were no procedure related deaths, strokes, or MI.

Endovascular stenting represents a technically feasible, safe, and clinically effective approach in selected patients with traumatic extracranial ICA or vertebral artery dissections. This procedure may be successful in the case of acute ischemic sequelae, as well as when anticoagulation is contraindicated or has failed, and may preclude the need for long-term anticoagulation.

ICA or vertebral artery traumatic dissection can be treated effectively with endovascular stenting as an alternative to anticoagulation; stenting may serve to resolve or prevent brain ischemia.

Mahgerefteh, S, Moscovici, S, Ramirez-de-Noriega, F, Paldor, I, Bedussa, N, Itshayek, E, Gomori, J, Cohen, J, Traumatic Dissection of Extracranial Carotid or Vertebral Arteries: Management with Stent-Assisted Angioplasty.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12032409.html