TY - JOUR
T1 - Natural history and management of blunt traumatic pseudoaneurysms of the internal carotid artery
T2 - The harbor view algorithm based off a 10-year experience
AU - Morton, Ryan P.
AU - Levitt, Michael R.
AU - Emerson, Samuel
AU - Ghodke, Basavaraj V.
AU - Hallam, Danial K.
AU - Sekhar, Laligam N.
AU - Kim, Louis J.
AU - Chesnut, Randall M.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Objective: To define the natural history of, and treatment strategy for, blunt traumatic internal carotid artery (ICA) pseudoaneurysms. Background: The natural history and management of traumatic ICA pseudoaneurysms is controversial. Methods: We retrospectively identified all traumatic ICA pseudoaneurysms diagnosed on head/neck computed tomographic angiography at a highvolume trauma center over a 10-year period. Radiographic and clinical data were recorded, and a treatment algorithm was derived. Results: Forty-three pseudoaneurysms were diagnosed in 39 patients. All patients were treated with daily aspirin unless contraindicated, and 82% underwent daily transcranial Doppler ultrasonography with embolic monitoring. A rate of 8 or more emboli per hour was predictive of embolic stroke (P = 0.0076). Acute ischemic or embolic stroke was seen in 7 patients (16%) with an overall mortality in this subpopulation of 42% (n = 3). Four patients (9%) underwent acute surgical treatment (parent vessel sacrifice and/or arterial bypass) for ongoing ischemia. Long-term radiographic and clinical follow-up was obtained for 36 surviving patients (mean = 8 months; range: 1 week-5 years), all of whom were maintained on daily aspirin. No delayed ischemic or embolic events were reported. For ICA pseudoaneurysms treated with aspirin and observation alone, 9 (28%) increased in size, 17 (53%) decreased or stabilized, and 6 (19%) resolved. Enlargement of 5 mm or more in maximal diameter underwent delayed endovascular treatment with a 100% obliteration rate and no complications. Conclusions: Traumatic ICA pseudoaneurysms are safely treated with daily aspirin, embolic monitoring, and radiographic surveillance. Acute stroke or hemorrhage, or delayed radiographic progression, are indications for endovascular or surgical treatment.
AB - Objective: To define the natural history of, and treatment strategy for, blunt traumatic internal carotid artery (ICA) pseudoaneurysms. Background: The natural history and management of traumatic ICA pseudoaneurysms is controversial. Methods: We retrospectively identified all traumatic ICA pseudoaneurysms diagnosed on head/neck computed tomographic angiography at a highvolume trauma center over a 10-year period. Radiographic and clinical data were recorded, and a treatment algorithm was derived. Results: Forty-three pseudoaneurysms were diagnosed in 39 patients. All patients were treated with daily aspirin unless contraindicated, and 82% underwent daily transcranial Doppler ultrasonography with embolic monitoring. A rate of 8 or more emboli per hour was predictive of embolic stroke (P = 0.0076). Acute ischemic or embolic stroke was seen in 7 patients (16%) with an overall mortality in this subpopulation of 42% (n = 3). Four patients (9%) underwent acute surgical treatment (parent vessel sacrifice and/or arterial bypass) for ongoing ischemia. Long-term radiographic and clinical follow-up was obtained for 36 surviving patients (mean = 8 months; range: 1 week-5 years), all of whom were maintained on daily aspirin. No delayed ischemic or embolic events were reported. For ICA pseudoaneurysms treated with aspirin and observation alone, 9 (28%) increased in size, 17 (53%) decreased or stabilized, and 6 (19%) resolved. Enlargement of 5 mm or more in maximal diameter underwent delayed endovascular treatment with a 100% obliteration rate and no complications. Conclusions: Traumatic ICA pseudoaneurysms are safely treated with daily aspirin, embolic monitoring, and radiographic surveillance. Acute stroke or hemorrhage, or delayed radiographic progression, are indications for endovascular or surgical treatment.
KW - Blunt cerebrovascular injury
KW - Carotid cavernous fistula
KW - Pseudoaneurysm
KW - Stroke
KW - Transcranial Doppler ultrasonography
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U2 - 10.1097/SLA.0000000000001158
DO - 10.1097/SLA.0000000000001158
M3 - Article
C2 - 25692360
AN - SCOPUS:84945274825
VL - 263
SP - 821
EP - 826
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 4
ER -