Semin intervent Radiol 2010; 27(1): 044-054
DOI: 10.1055/s-0030-1247888
© Thieme Medical Publishers

Endovascular Management of Neurovascular Arterial Injuries in the Face and Neck

Martin G. Radvany1 , 2 , Philippe Gailloud1
  • 1Division of Interventional Neuroradiology, Johns Hopkins Hospital, Baltimore, Maryland
  • 2Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland
Further Information

Publication History

Publication Date:
17 March 2010 (online)

ABSTRACT

The diagnosis and treatment of traumatic vascular injuries continues to improve as new tools and techniques are developed. In addition to locoregional hemorrhagic complications, injuries to blood vessels in the neck and face can result in ischemic injuries to the brain and cervical spinal cord. Surgical access to these lesions may be difficult, and endovascular techniques, including stenting and embolization, now serve as definitive treatments in many instances. This article reviews the endovascular management of patients with arterial injuries in the neck and face.

REFERENCES

  • 1 WHO .The top 10 causes of death. Available at: http://www.who.int/mediacentre/factsheets/fs310/en/index.html Accessed July 3, 2009
  • 2 CDC. Scientific Data .Statistics, and Surveillance. Available at: http://www.cdc.gov/injury/wisqars/dataandstats.html Accessed July 2, 2009
  • 3 Pfeifer R, Tarkin I S, Rocos B, Pape H C. Patterns of mortality and causes of death in polytrauma patients—has anything changed?.  Injury. 2009;  40 907-911
  • 4 Landreneau R J, Weigelt J A, Megison S M, Meier D E, Fry W J. Combined carotid-vertebral arterial trauma.  Arch Surg. 1992;  127 301-304
  • 5 Saletta J D, Lowe R J, Lim L T, Thornton J, Delk S, Moss G S. Penetrating trauma of the neck.  J Trauma. 1976;  16 579-587
  • 6 Ray Jr C E, Spalding S C, Cothren C C, Wang W S, Moore E E, Johnson S P. State of the art: noninvasive imaging and management of neurovascular trauma.  World J Emerg Surg. 2007;  2 1
  • 7 Fakhry S M, Jaques P F, Proctor H J. Cervical vessel injury after blunt trauma.  J Vasc Surg. 1988;  8 501-508
  • 8 Kerwin A J, Bynoe R P, Murray J et al.. Liberalized screening for blunt carotid and vertebral artery injuries is justified.  J Trauma. 2001;  51 308-314
  • 9 Biffl W L, Moore E E, Offner P J, Brega K E, Franciose R J, Burch J M. Blunt carotid arterial injuries: implications of a new grading scale.  J Trauma. 1999;  47 845-853
  • 10 Cothren C C, Moore E E, Biffl W L et al.. Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate.  Arch Surg. 2004;  139 540-545 discussion 545-546
  • 11 Biffl W L, Ray Jr C E, Moore E E et al.. Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography.  Ann Surg. 2002;  235 699-706 discussion 706-707
  • 12 Fabian T C, Patton Jr J H, Croce M A, Minard G, Kudsk K A, Pritchard F E. Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy.  Ann Surg. 1996;  223 513-522 discussion 522-525
  • 13 Biffl W L, Moore E E, Ryu R K et al.. The unrecognized epidemic of blunt carotid arterial injuries: early diagnosis improves neurologic outcome.  Ann Surg. 1998;  228 462-470
  • 14 Crissey M M, Bernstein E F. Delayed presentation of carotid intimal tear following blunt craniocervical trauma.  Surgery. 1974;  75 543-549
  • 15 Biffl W L, Moore E E, Offner P J, Burch J M. Blunt carotid and vertebral arterial injuries.  World J Surg. 2001;  25 1036-1043
  • 16 Biffl W L, Ray Jr C E, Moore E E et al.. Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography.  Ann Surg. 2002;  235 699-706 discussion 706-707
  • 17 Husni E A, Bell H S, Storer J. Mechanical occlusion of the vertebral artery. A new clinical concept.  JAMA. 1966;  196 475-478
  • 18 Braun I F, Pinto R S, De Filipp G J, Lieberman A, Pasternack P, Zimmerman R D. Brain stem infarction due to chiropractic manipulation of the cervical spine.  South Med J. 1983;  76 1507-1510
  • 19 Ray Jr C E, Spalding S C, Cothren C C, Wang W S, Moore E E, Johnson S P. State of the art: noninvasive imaging and management of neurovascular trauma.  World J Emerg Surg. 2007;  2 1
  • 20 Sclafani S J, Panetta T, Goldstein A S et al.. The management of arterial injuries caused by penetration of zone III of the neck.  J Trauma. 1985;  25 871-881
  • 21 McKevitt E C, Kirkpatrick A W, Vertesi L, Granger R, Simons R K. Blunt vascular neck injuries: diagnosis and outcomes of extracranial vessel injury.  J Trauma. 2002;  53 472-476
  • 22 Timberlake G A, Rice J C, Kerstein M D, Rush D S, McSwain Jr N E. Penetrating injury to the carotid artery. A reappraisal of management.  Am Surg. 1989;  55 154-157
  • 23 Serbinenko F A. Balloon catheterization and occlusion of major cerebral vessels.  J Neurosurg. 1974;  41 125-145
  • 24 Johnson D W, Stringer W A, Marks M P, Yonas H, Good W F, Gur D. Stable xenon CT cerebral blood flow imaging: rationale for and role in clinical decision making.  AJNR Am J Neuroradiol. 1991;  12 201-213
  • 25 Mathis J M, Barr J D, Jungreis C A et al.. Temporary balloon test occlusion of the internal carotid artery: experience in 500 cases.  AJNR Am J Neuroradiol. 1995;  16 749-754
  • 26 Eckard D A, Purdy P D, Bonte F J. Temporary balloon occlusion of the carotid artery combined with brain blood flow imaging as a test to predict tolerance prior to permanent carotid sacrifice.  AJNR Am J Neuroradiol. 1992;  13 1565-1569
  • 27 Moody E B, Dawson III R C, Sandler M P. 99mTc-HMPAO SPECT imaging in interventional neuroradiology: validation of balloon test occlusion.  AJNR Am J Neuroradiol. 1991;  12 1043-1044
  • 28 Colella J J, Diamond D L. Blunt carotid injury: reassessing the role of anticoagulation.  Am Surg. 1996;  62 212-217
  • 29 Martin R F, Eldrup-Jorgensen J, Clark D E, Bredenberg C E. Blunt trauma to the carotid arteries.  J Vasc Surg. 1991;  14 789-793 discussion 793-795
  • 30 Fabian T C, Patton Jr J H, Croce M A, Minard G, Kudsk K A, Pritchard F E. Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy.  Ann Surg. 1996;  223 513-522 discussion 522-525
  • 31 Cothren C C, Moore E E, Ray Jr C E et al.. Carotid artery stents for blunt cerebrovascular injury: risks exceed benefits.  Arch Surg. 2005;  140 480-485 discussion 485-486
  • 32 Piotin M, Mandai S, Murphy K J et al.. Dense packing of cerebral aneurysms: an in vitro study with detachable platinum coils.  AJNR Am J Neuroradiol. 2000;  21 757-760
  • 33 TRUFILL® n-Butyl Cyanoacrylate (n-BCA) Liquid Embolic System—P990040. Available at: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cftopic/pma/pma.cfm?num=p990040 Accessed July 3, 2009
  • 34 Cantasdemir M, Adaletli İ, Cebi D, Kantarci F, Selcuk N D, Numan F. Emergency endovascular embolization of traumatic intrarenal arterial pseudoaneurysms with N-butyl cyanoacrylate.  Clin Radiol. 2003;  58 560-565
  • 35 Kish J W, Katz M D, Marx M V, Harrell D S, Hanks S E. N-butyl cyanoacrylate embolization for control of acute arterial hemorrhage.  J Vasc Interv Radiol. 2004;  15 689-695
  • 36 Luo C B, Teng M M, Chang F C, Chang C Y. Transarterial embolization of acute external carotid blowout syndrome with profuse oronasal bleeding by N-butyl-cyanoacrylate.  Am J Emerg Med. 2006;  24 702-708
  • 37 Malek A M, Higashida R T, Phatouros C C et al.. Endovascular management of extracranial carotid artery dissection achieved using stent angioplasty.  AJNR Am J Neuroradiol. 2000;  21 1280-1292
  • 38 Cothren C C, Moore E E, Ray Jr C E et al.. Carotid artery stents for blunt cerebrovascular injury: risks exceed benefits.  Arch Surg. 2005;  140 480-485 discussion 485-486
  • 39 Bush R L, Lin P H, Dodson T F, Dion J E, Lumsden A B. Endoluminal stent placement and coil embolization for the management of carotid artery pseudoaneurysms.  J Endovasc Ther. 2001;  8 53-61
  • 40 Kadkhodayan Y, Jeck D T, Moran C J, Derdeyn C P, Cross III D T. Angioplasty and stenting in carotid dissection with or without associated pseudoaneurysm.  AJNR Am J Neuroradiol. 2005;  26 2328-2335
  • 41 Chandler J P, Sekhar L N. Intravascular stents and cerebrovascular disease.  Crit Rev Neurosurg. 1997;  7 315-323
  • 42 Cothren C C, Moore E E, Ray Jr C E et al.. Carotid artery stents for blunt cerebrovascular injury: risks exceed benefits.  Arch Surg. 2005;  140 480-485 discussion 485-486

Martin G RadvanyM.D. F.S.I.R. 

Assistant Professor Radiology, Division of Interventional Neuroradiology, Johns Hopkins Hospital

600 N. Wolfe Street, Radiology B-100, Baltimore, MD 21287

Email: mradvan2@jhmi.edu