PMID- 18301205
OWN - NLM
STAT- MEDLINE
DCOM- 20080307
LR  - 20220331
IS  - 1529-8809 (Electronic)
IS  - 0022-5282 (Linking)
VI  - 64
IP  - 2
DP  - 2008 Feb
TI  - Internal carotid artery stenting for blunt carotid artery injuries with an 
      associated pseudoaneurysm.
PG  - 398-405
LID - 10.1097/TA.0b013e31815eb788 [doi]
AB  - BACKGROUND: Blunt carotid artery injuries (BCI) are being recognized and treated 
      with increasing frequency because of improved screening protocols. Recent 
      advances in endovascular techniques using microcoils, angioplasty, and stenting 
      offer a new treatment strategy for those patients with traumatic pseudoaneurysms 
      (PA) (BCI and PA). Experience with these techniques is limited because of the 
      rarity of these injuries. HYPOTHESIS: Early anticoagulation (AC) or antiplatelet 
      (AP) therapy combined with carotid artery stenting is a safe alternative to AC 
      alone for the treatment of grade III carotid artery injuries (BCI and PA). 
      DESIGN: Prospective cohort study. SETTING: A rural, community Level I trauma 
      center. PATIENTS AND METHODS: All patients with a nonocclusive BCI and PA during 
      a 5.5 year period from June 23, 2000 to December 31, 2005 were included in the 
      study. RESULTS: : Eleven patients with grade BCI and PA underwent endovascular 
      repair. Nine patients (81%) had associated traumatic intracranial hemorrhage. AC 
      (heparin drip) or AP therapy (clopidogrel or aspirin or both) was initiated in 
      all patients within 48 hours of diagnosis of BCI. Time from admission to AC or AP 
      was 21 +/- 9.5 hours (mean +/- SD). Mortality rate was 18% (2 of 11). One death 
      was attributed to severe brain injury. The other was attributed to a stroke from 
      the carotid injury. No patient had radiologic progression of traumatic 
      intracranial hemorrhage on head computed tomography despite AP or AC. One patient 
      sustained a mild embolic cerebrovascular ischemic event before stenting. No other 
      survivors developed a stroke or any other evidence of cerebral ischemic symptoms. 
      Two recurrent PAs developed during hospitalization and were successfully managed 
      with an additional stent. All survivors were discharged with a good neurologic 
      outcome. Seven patients had follow-up from 6 months to 4 years: one developed 
      asymptomatic 50% stenosis at 6 months requiring successful angioplasty. All 
      others showed complete healing without stenosis. CONCLUSIONS: Carotid artery 
      stenting is safe and effective initial therapy for patients with nonocclusive BCI 
      and PA. Initial intermediate-term follow-up also fails to demonstrate significant 
      morbidity for up to 4 years.
FAU - Berne, John D
AU  - Berne JD
AD  - Division of Trauma Surgery, East Texas Medical Center, Tyler, TX, USA.
FAU - Reuland, Kurt R
AU  - Reuland KR
FAU - Villarreal, David H
AU  - Villarreal DH
FAU - McGovern, Thomas M
AU  - McGovern TM
FAU - Rowe, Stephen A
AU  - Rowe SA
FAU - Norwood, Scott H
AU  - Norwood SH
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Trauma
JT  - The Journal of trauma
JID - 0376373
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Accidents, Traffic
MH  - Adolescent
MH  - Adult
MH  - Aneurysm, False/diagnostic imaging/etiology/*therapy
MH  - Aspirin/therapeutic use
MH  - Carotid Artery Injuries/complications/diagnostic imaging/*therapy
MH  - Carotid Artery, Internal/*diagnostic imaging
MH  - Clopidogrel
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Prospective Studies
MH  - *Stents
MH  - Ticlopidine/analogs & derivatives/therapeutic use
MH  - Tomography, X-Ray Computed
MH  - Wounds, Nonpenetrating/complications/*therapy
EDAT- 2008/02/28 09:00
MHDA- 2008/03/08 09:00
CRDT- 2008/02/28 09:00
PHST- 2008/02/28 09:00 [pubmed]
PHST- 2008/03/08 09:00 [medline]
PHST- 2008/02/28 09:00 [entrez]
AID - 00005373-200802000-00022 [pii]
AID - 10.1097/TA.0b013e31815eb788 [doi]
PST - ppublish
SO  - J Trauma. 2008 Feb;64(2):398-405. doi: 10.1097/TA.0b013e31815eb788.