Endovascular reconstruction of extracranial traumatic internal carotid artery dissections: a systematic review

• Published in: Neurosurgical review 2020-06, Vol.43 (3), p.931-940
• Main Authors: Texakalidis, Pavlos, Karasavvidis, Theofilos, Giannopoulos, Stefanos, Tzoumas, Andreas, Charisis, Nektarios, Jabbour, Pascal, Machinis, Theofilos, Rangel-Castilla, Leonardo, Reavey-Cantwell, John
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Neurosurgery; Review
• ISSN: 0344-5607; 1437-2320
• DOI: 10.1007/s10143-019-01092-6

Extracranial internal carotid artery dissection (ICAD) is a potential source of morbidity and mortality in trauma patients and requires high degree of suspicion for diagnosis after the initial presentation. Occasionally, if standard therapy is contraindicated, 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. A comprehensive systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed and Cochrane Library databases were searched. Twenty-four studies comprising 191 patients (204 lesions) were included; 179 underwent traditional carotid artery stenting (CAS), whereas 12 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 below 2.2% for stroke, transient ischemic attack, and mortality. During follow-up in the CAS group, there was no incidence of ICAD-related stroke or death and 2.2% of patients underwent a repeat CAS procedure. In the PED group, no patient 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. Endovascular reconstruction of traumatic or iatrogenic ICAD appears safe. This approach demonstrated acceptable short- and long-term clinical and radiographic outcomes in both groups.