Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: results in 234 cases

TLDR

Traumatic head and neck injuries that create arteriovenous fistulae are difficult to treat surgically because of their location, patient instability, and challenges in pinpointing the injury site, prompting a shift toward endovascular therapy under local anesthesia. The study evaluated 234 consecutive traumatic carotid or vertebral artery injuries from 1974 to 1988, using detachable balloons, liquid adhesives, microcoils, and silk sutures to occlude fistulae while preserving the parent vessel. Fistula occlusion was achieved in 82% of cases, while 18% required parent vessel occlusion due to extensive injury or subtotal fistula occlusion, with complications including transient cerebral ischemia, pseudoaneurysm, stroke, and a single peripheral nerve injury.

Abstract

Traumatic injuries to the head and neck that result in arteriovenous fistulae are often difficult to treat by direct surgical access. This is because of anatomic location, instability of the acutely injured patient, and difficulty in localizing the exact site of injury. Between 1974 and 1988, 234 consecutive cases of traumatic injuries to the carotid or vertebral artery were evaluated by our group for intravascular embolization therapy. This included 206 cases of direct and seven cases of indirect carotid-cavernous sinus fistulae and 21 cases of traumatic vertebral fistulae. A variety of devices including detachable balloons, liquid tissue adhesives, microcoils, and silk suture were used with the goal of fistula occlusion and preservation of the parent vessel. This was achieved in 193 cases (82%). In the remaining 41 cases (18%), the carotid or vertebral artery had to be occluded by endovascular occlusion techniques because of extensive vascular injury in 28 cases and subtotal occlusion of the fistula in 13 cases. Complications included transient cerebral ischemia in six cases, pseudoaneurysm formation in five cases, stroke in five cases, and peripheral nerve injury in one case. The development of interventional neurovascular techniques has altered the management of these acutely injured patients. The preferred method for treatment has shifted from direct surgical access under general anesthesia to endovascular therapy under local anesthesia.