The changing role of endovascular stenting for blunt cerebrovascular injuries

Charles P. Shahan, John P. Sharpe, Shaun M. Stickley, Nate R. Manley, Dina M. Filiberto, Timothy C. Fabian, Martin A. Croce, Louis J. Magnotti

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

BACKGROUND Few injuries have produced as much debate with respect to management as have blunt cerebrovascular injuries (BCVIs). Without question, early anticoagulation is the mainstay of therapy for these injuries. However, the role of endovascular stenting for BCVI remains controversial. Our purpose was to examine the use of endovascular stents for BCVI and outcomes and describe which injuries are being treated with stents. METHODS Patients with BCVI from 2011 to 2016 were identified and stratified by age, sex, and injury severity. Patients were then divided into two groups (previous study [PS] = 2011-2012 and current study [CS] = 2013-2016) based on a paradigm shift in BCVI diagnosis and treatment at our institution. Beginning in 2013, a multidisciplinary team assumed care of patients with BCVI from interventional radiology. Digital subtraction angiography was used to confirmatory injuries in both groups and heparin used for initial therapy. RESULTS In the CS, 237 patients were diagnosed with BCVI compared with 128 patients in the PS. Both groups were clinically similar with no difference in distribution of vessels injured. Beginning in 2013, there was a significant decrease in the use of stents for these injuries. In fact, in the CS, only 21 (8.9%) patients were treated with endovascular stenting compared to 44 (34%) patients in the PS. Of patients in the CS, 14 had grade III pseudoaneurysms and seven had grade II dissections. Despite this reduction in stenting, there was no significant change in the BCVI-related stroke rate between the CS and the PS (4.2% vs. 3.9%). CONCLUSION Anticoagulation alone is adequate therapy for the majority of BCVI. Nevertheless, there is still a role for endovascular stents in the treatment of BCVI. Their use should be reserved for enlarging carotid pseudoaneurysms and dissections with significant narrowing. The prospect of determining which injuries benefit from stent placement warrants prospective investigation. LEVEL OF EVIDENCE Therapuetic/care management, level IV.

Original languageEnglish (US)
Pages (from-to)308-311
Number of pages4
JournalJournal of Trauma and Acute Care Surgery
Volume84
Issue number2
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

Keywords

  • Blunt cerebrovascular injury
  • blunt carotid injury
  • carotid stent
  • carotid trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'The changing role of endovascular stenting for blunt cerebrovascular injuries'. Together they form a unique fingerprint.

Cite this