Emergency Endovascular Interventions of Traumatic Cranial and Extracranial Injuries

ABSTRACT

Traumatic head and neck, and cerebrovascular injuries may result in a devastating consequence of vascular injuries involving the major cervical and cerebral vessels, potentially leading to hemorrhage, stroke, or death. Vascular injury may result in vessel transection, laceration, false aneurysm, arteriovenous fistula, or thrombosis. Massive hemorrhage may occur secondary to blunt, penetrating, or iatrogenic trauma. Surgical treatment, while at times curative, cannot always be performed, particularly when the location of the injury or the patient's unstable condition precludes surgical options. Endovascular treatment options include the use of uncovered or covered stents, endovascular coils and balloons, as well as liquid or solid embolic materials in reconstructing damaged arterial lumens, controlling pseudoaneurysm formation or lacerations, or when necessary, vessel sacrifice. The authors describe recent and ongoing developments in endovascular techniques and illustrate treatments that are currently available to the interventionalist for repair of these traumatic lesions.

KEYWORDS

Head and neck trauma - carotid artery - vertebral artery - intervention - endovascular

REFERENCES

• 1 Mehringer C M, Hieshima G B, Grinnell V S. et al . Therapeutic embolization for vascular trauma of the head and neck.  AJNR Am J Neuroradiol . 1983;  4 137-142
• 2 Liebman K M, Rosenwasser R H, Heinel L A. Endovascular management of aneurysm and carotid-cavernous fistulae from gunshot wounds to the skull base and oropharynx.  J Craniomaxillofac Trauma . 1996;  2 10-16
• 3 Rahmat H, Amirjamshid A, Kamalian N. Traumatic aneurysm of the facial artery caused by missile injury.  J Oral Maxillofac Surg . 1985;  43 990-992
• 4 Borsa J J, Fontaine A B, Eskridge J M. et al . Transcatheter arterial embolization for intractable epistaxis secondary to gunshot wounds.  J Vasc Interv Radiol . 1999;  10 297-302
• 5 Friedman A H. Traumatic injury of neck and intracranial vessels.  Contemp Neurosurg . 1990;  12 1-6
• 6 Cogbill T H, Moore E E, Meissner M. et al . The spectrum of blunt injury to the carotid artery: a multicenter perspective.  J Trauma . 1994;  37 473-479
• 7 Demetriades D, Chahwan S, Gomez H. et al . Initial evaluation and management of gunshot wounds to the face.  J Trauma . 1998;  45 39-41
• 8 McKevitt E, Kirkpatrick A, Vertesi L. et al . Identifying patients at risk for intracranial and extracranial blunt carotid injuries.  Am J Surg . 2002;  183 566-570
• 9 Remonda L, Schroth G, Caversaccio M. et al . Endovascular treatment of acute and subacute hemorrhage in the head and neck.  Arch Otolaryngol Head Neck Surg . 2000;  126 1255-1262
• 10 Walker A T, Chaloupka J C, Putman C M. et al . Sentinel transoral hemorrhage from a pseudoaneurysm of the internal maxillary artery: a complication of CT-guided biopsy of the masticator space.  AJNR Am J Neuroradiol . 1996;  17 377-381
• 11 Rogers S N, Patel M, Beirne J C. et al . Traumatic aneurysm of the maxillary artery: the role of interventional radiology.  Int J Oral Maxillofac Surg . 1995;  5 336-339
• 12 Chen D, Concus A P, Halbach V V. et al . Epistaxis originating from traumatic pseudoaneurysm of the internal carotid artery: diagnosis and endovascular therapy.  Laryngoscope . 1998;  108 326-331
• 13 Cohen S, Anastassov G E, Chuang S K. Posttraumatic pseudoaneurysm of the sphenopalatine artery presenting as persistent epistaxis: diagnosis and management.  J Trauma . 1999;  47 396-399
• 14 Kurata A, Kitahara T, Miyasaka Y. et al . Superselective embolization for severe traumatic epistaxis caused by fracture of the skull base.  AJNR Am J Neuroradiol . 1993;  14 343-345
• 15 Buchanan R T, Holtmann B. Severe epistaxis in facial fractures.  Plast Reconstr Surg . 1983;  71 768-771
• 16 Reiber M E, Burkey B B. Intracavernous carotid pseudoaneurysm after blunt trauma: case report and discussion.  Head Neck . 1994;  16 253-258
• 17 Tomsick T A. Carotid-cavernous fistulas. In: Marks MP, Do HM, eds. Endovascular and Percutaneous Therapy of the Brain and Spine Philadelphia: Lippincott Williams & Wilkins; 2002: 317-336
• 18 Biffl W, Ray C, Moore E. et al . Treatment related outcomes from blunt cerebrovascular injuries.  Ann Surg . 2002;  235 699-707
• 19 Higashida R T, Halbach H V, Tsai F Y. et al . Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: results in 234 cases.  AJR Am J Roentgenol . 1989;  153 577-582
• 20 Panetta T, Sclafani S J, Goldstein A S. et al . Percutaneous transcatheter embolization for arterial trauma.  J Vasc Surg . 1985;  2 54-64
• 21 Murakami R, Kumazaki T, Tajima H. et al . Transcatheter arterial embolization as treatment for life-threatening maxillofacial injury.  Radiat Med . 1996;  14 197-199
• 22 Yamaura I, Tani E, Yokota M. et al . Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils.  J Neurosurg . 1999;  90 853-856
• 23 Sanchez F, Delgado F, Ramos M. Pseudoaneurysm of the superficial temporal artery treated by embolization: report of a case.  J Oral Maxillofac Surg . 2000;  58 819-821
• 24 Bernstein S M, Coldwell D M, Prall J A, Brega K E. Treatment of traumatic carotid pseudoaneurysm with endovascular stent placement.  J Vasc Interv Radiol . 1997;  8 1065-1068
• 25 Horowitz M B, Miller G, Meyer Y. et al . Use of intravascular stents in the treatment of internal carotid and extracranial vertebral artery pseudoaneurysms.  AJNR Am J Neuroradiol . 1996;  17 693-696
• 26 Koenigsberg R A, Gradenetti L, McCormick D, Faro S H, Tsai F Y. Endovascular repair of radiation-induced bilateral common carotid artery stenosis and pseudoaneurysms: a case report.  Surgical Neurol . 2001;  55 347-352
• 27 Klein G E, Szolar D H, Raith J, Fruhwirth H, Pascher O, Hausegger K A. Posttraumatic extracranial aneurysm of the internal carotid artery: combined endovascular treatment with coils and stents.  AJNR Am J Neuroradiol . 1997;  18 1261-1264
• 28 Osborne A G. Diagnostic Cerebral Angiography; 2nd ed. Philadelphia: Lippincott Williams & Wilkins; . 1999: 405-417
• 29 Watridge C B, Muhlbauer M S, Lowery R D. Traumatic carotid artery dissection: diagnosis and treatment.  J Neurosurg . 1989;  71 854
• 30 Reiber M E, Burkey B B. Intracavernous carotid pseudoaneurysm after blunt trauma: case report and discussion.  Head Neck . 1994;  16 253-258
• 31 Alexander M, Smith T, Tucci D. Treatment of an iatrogenic petrous carotid artery pseudoaneurysm with a symbiot covered stent.  Neurosurgery . 2002;  50 658-662