Endovascular Reconstruction of Extracranial Traumatic Internal Carotid Artery Dissections: a Systematic Review
Nektarios Charisis, M.D.1, Pavlos Texakalidis, M.D.2, Theofilos Karasavvidis, M.S.3, Stefanos Giannopoulos, M.D.4, Theofilos Machinis, M.D.5, John Reavey-Cantwell, M.D.5, George J. Koullias, M.D. Ph.D.1.
1Stony Brook University Hospital, Stony Brook, NY, USA, 2Emory University Hospital, Atlanta, GA, USA, 3Medical School, Aristotle Univerity of Thessaloniki, Thessaloniki, Greece, 4251 HAF and VA Hospital, Athens, Greece, 5Virginia Commonwealth University, Richmond, VA, USA.
OBJECTIVES: Extracranial internal carotid artery dissection (ICAD) is a potential source of morbidity and mortality in trauma patients and requires a high degree of suspicion for diagnosis after the initial presentation. Occasionally, trauma patients have contraindications for standard medical management; in this scenario and for patients who fail medical therapy, endovascular reconstruction is a treatment option. The aim of this systematic review was to report clinical and radiographic outcomes following endovascular repair of ICAD of traumatic and iatrogenic etiology.
METHODS: A comprehensive systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The PubMed and Cochrane Library databases were searched up to May 2018.
RESULTS: A total of 24 studies, comprising 191 patients and 204 lesions were included; 179 of those underwent traditional carotid artery stenting (CAS) whereas twelve patients underwent flow diversion with the pipeline embolization device (PED). In total, 75.7% of the CAS group and 66.6% of the PED group presented with ICAD-related symptomatology. Concomitant pseudoaneurysms were identified in 61.9% and 78.5% of lesions in the CAS and PED group respectively. Adverse event rates among CAS treated lesions after 30-day follow-up were 1.1% for stroke, 2.2% for transient ischemic attack and 2.2% for mortality. During a follow-up period of 28.9 months in the CAS group, there was no incidence of ICAD-related stroke or death and 2.2% of patients underwent a repeat CAS procedure. None of the patients in the PED group suffered stroke or death in the reported follow-up. In the PED cohort, there was an adequate occlusion rate and no patient had to be retreated.
CONCLUSIONS: Endovascular reconstruction of traumatic or iatrogenic ICAD appears safe and feasible. This approach demonstrated acceptable short and long-term clinical and radiographic outcomes in both the CAS and PED groups.
Back to 2019 ePosters