Endovascular stenting is rarely necessary for the management of blunt cerebrovascular injuries.

Abstract

BACKGROUND:

The role of stenting for blunt cerebrovascular injuries (BCVI) continues to be debated, with a trend toward more endovascular stenting. With the recent intracranial stenting trial halted in favor of medical therapy, however, management of BCVI warrants reassessment. The study purpose was to determine if antithrombotic therapy, rather than stenting, was effective in post-injury patients with high-grade vascular dissections and pseudoaneurysms.

STUDY DESIGN:

In 1996, we began screening for BCVI. After the 2005 report on the risks of carotid stenting for BCVI, a virtual moratorium was placed on stenting at our institution; our primary therapy for BCVI has been antithrombotics. Patients with grade II (luminal narrowing >25%) and grade III (pseudoaneurysms) injuries were included in the analysis.

RESULTS:

Grade II or III BCVIs were diagnosed in 195 patients. Before 2005, 25% (21 of 86) of patients underwent stent placement, with 2 patients suffering stroke. Of patients treated with antithrombotics, 1 had a stroke. After 2005, only 2% (2 of 109) of patients with high-grade injuries had stents placed. After 2005, no patient treated with antithrombotics suffered a stroke and there was no rupture of a pseudoaneurysm.

CONCLUSIONS:

Antithrombotic treatment for BCVI is effective for stroke prevention. Routine stenting entails increased costs and potential risk for stroke, and does not appear to provide additional benefit. Intravascular stents should be reserved for the rare patient with symptomatology or a markedly enlarging pseudoaneurysm.

• Authors: Clay Cothren Burlew, Walter L Biffl, Ernest E Moore, Fredric M Pieracci, Kathryn M Beauchamp, Robert Stovall, Amy E Wagenaar, Gregory J Jurkovich
• Journal: Journal of the American College of Surgeons (J Am Coll Surg) Vol. 218 Issue 5 Pg. 1012-7 (May 2014) ISSN: 1879-1190 [Electronic] United States
• PMID: 24661857 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Brain Injuries (complications, diagnostic imaging, surgery)
• Carotid Artery Injuries (diagnostic imaging, etiology, surgery)
• Carotid Artery, Internal (diagnostic imaging, surgery)
• Cerebral Angiography
• Child
• Child, Preschool
• Endovascular Procedures (methods)
• Female
• Follow-Up Studies
• Humans
• Infant
• Male
• Middle Aged
• Retrospective Studies
• Stents
• Tomography, X-Ray Computed
• Treatment Outcome
• Vertebral Artery (diagnostic imaging, injuries, surgery)
• Wounds, Nonpenetrating (complications, diagnostic imaging, surgery)
• Young Adult