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J Neurol Surg A Cent Eur Neurosurg 2020; 81(03): 243-252
DOI: 10.1055/s-0039-1697604
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Unique Indications for Covered Stent Grafts in Neuroradiology Departments of Level 1 Trauma Centers

Leonie Goelz 
1   Unfallkrankenhaus Berlin, Department of Radiology and Neuroradiology, Berlin, Germany
4   Ernst Moritz Arndt Univ Greifswald KOR, Institute for Diagnostic Radiology and Neuroradiology, Greifswald, Germany
,
Lutz Kreißl
1   Unfallkrankenhaus Berlin, Department of Radiology and Neuroradiology, Berlin, Germany
,
Pawel Gutowski
2   Department of Neurosurgery, Unfallkrankenhaus Berlin, Berlin, Germany
,
Paul Sparenberg
3   Department of Neurology, Unfallkrankenhaus Berlin, Berlin, Germany
,
Michael Kirsch
4   Ernst Moritz Arndt Univ Greifswald KOR, Institute for Diagnostic Radiology and Neuroradiology, Greifswald, Germany
,
Sven Mutze
1   Unfallkrankenhaus Berlin, Department of Radiology and Neuroradiology, Berlin, Germany
4   Ernst Moritz Arndt Univ Greifswald KOR, Institute for Diagnostic Radiology and Neuroradiology, Greifswald, Germany
› Author Affiliations
Further Information

Publication History

17 February 2019

06 June 2019

Publication Date:
11 February 2020 (online)

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Abstract

Objective To describe unique indications for covered stent grafts in trauma-associated cerebrovascular injuries.

Patients Between 2006 and 2018, five patients with cerebrovascular injuries were treated with a covered stent graft. We present a retrospective analysis of technique and outcomes.

Results In all cases stent deployment was successful. Endoleaks occurred in two cases requiring additional transvenous embolization of a carotid cavernous fistula (CCF) in one patient. Two cases of in-stent thrombosis were observed during intervention and 2 days postintervention in a patient with a long-segment dissection of the internal carotid artery (ICA) and another patient with a contained ICA rupture, both of which could not be prepared with dual antiplatelet therapy. Intravenous heparin and intra-arterial tirofiban dissolved in-stent thrombosis efficiently. One CCF and an iatrogenic vertebral artery injury were covered adequately with GraftMaster stent grafts.

Conclusion Patient selection with regard to individual anatomy and the site of vascular lesions is essential for an uncomplicated deployment of covered stent grafts and the success of therapy. Management of dual antiplatelet therapy, anticoagulation, and an escalation of medication in cases of in-stent thrombosis require expertise, a strict therapeutic regime, and an evaluation of individual risks in polytraumatized patients.

Keywords

GraftMaster - Jostent - cerebrovascular injury - trauma - covered stent graft

Informed Consent

Informed consent was obtained from all individual participants included in the study for planned interventions. In emergency cases, consent for immediate therapy of the in-house patients was assumed.


 

  • References

  • 1 Sethi RKV, Kozin ED, Fagenholz PJ, Lee DJ, Shrime MG, Gray ST. Epidemiological survey of head and neck injuries and trauma in the United States. Otolaryngol Head Neck Surg 2014; 151 (05) 776-784
    CrossrefPubMedGoogle Scholar
  • 2 Rickels E. Überblick Schädel-Hirn-Trauma: Ursachen, Häufigkeit und Schweregrade. Schwerpunkt Schädel-Hirn-Trauma. Vol 6. Stuttgart, Germany: Thieme; 2014: 108-112
    Google Scholar
  • 3 Miller PR, Fabian TC, Croce MA. , et al. Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg 2002; 236 (03) 386-393 ; discussion 393–395
    CrossrefPubMedGoogle Scholar
  • 4 Weber CD, Lefering R, Kobbe P. , et al; TraumaRegister DGU. Blunt cerebrovascular artery injury and stroke in severely injured patients: an international multicenter analysis. World J Surg 2018; 42 (07) 2043-2053
    CrossrefPubMedGoogle Scholar
  • 5 Alao T, Waseem M. Neck Trauma. StatPearls. Treasure Island, FL: StatPearls; 2018
    Google Scholar
  • 6 Biffl WL, Moore EE, Ryu RK. , et al. The unrecognized epidemic of blunt carotid arterial injuries: early diagnosis improves neurologic outcome. Ann Surg 1998; 228 (04) 462-470
    CrossrefPubMedGoogle Scholar
  • 7 George E, Khandelwal A, Potter C. , et al. Blunt traumatic vascular injuries of the head and neck in the ED. Emerg Radiol 2019; 26 (01) 75-85
    CrossrefPubMedGoogle Scholar
  • 8 Lockwood MM, Smith GA, Tanenbaum J. , et al. Screening via CT angiogram after traumatic cervical spine fractures: narrowing imaging to improve cost effectiveness. Experience of a Level I trauma center. J Neurosurg Spine 2016; 24 (03) 490-495
    CrossrefPubMedGoogle Scholar
  • 9 Lunardini DJ, Eskander MS, Even JL. , et al. Vertebral artery injuries in cervical spine surgery. Spine J 2014; 14 (08) 1520-1525
    CrossrefPubMedGoogle Scholar
  • 10 Guan Q, Chen L, Long Y, Xiang Z. Iatrogenic Vertebral artery injury during anterior cervical spine surgery: a systematic review. World Neurosurg 2017; 106: 715-722
    CrossrefPubMedGoogle Scholar
  • 11 Laser A, Kufera JA, Bruns BR. , et al. Initial screening test for blunt cerebrovascular injury: validity assessment of whole-body computed tomography. Surgery 2015; 158 (03) 627-635
    CrossrefPubMedGoogle Scholar
  • 12 Grandhi R, Weiner GM, Agarwal N. , et al. Limitations of multidetector computed tomography angiography for the diagnosis of blunt cerebrovascular injury. J Neurosurg 2018; 128 (06) 1642-1647
    PubMedGoogle Scholar
  • 13 Malhotra AK, Camacho M, Ivatury RR. , et al. Computed tomographic angiography for the diagnosis of blunt carotid/vertebral artery injury: a note of caution. Ann Surg 2007; 246 (04) 632-642 , discussion 642–643
    CrossrefPubMedGoogle Scholar
  • 14 Shahan CP, Magnotti LJ, Stickley SM. , et al. A safe and effective management strategy for blunt cerebrovascular injury: avoiding unnecessary anticoagulation and eliminating stroke. J Trauma Acute Care Surg 2016; 80 (06) 915-922
    CrossrefPubMedGoogle Scholar
  • 15 Rückert RI, Rutsch W, Filimonow S, Lehmann R. Successful stent-graft repair of a vertebrojugular arteriovenous fistula. J Endovasc Ther 2001; 8 (05) 495-500
    CrossrefPubMedGoogle Scholar
  • 16 Tseng A, Ramaiah V, Rodriguez-Lopez JA. , et al. Emergent endovascular treatment of a spontaneous internal carotid artery dissection with pseudoaneurysm. J Endovasc Ther 2003; 10 (03) 643-646
    PubMedGoogle Scholar
  • 17 Shakir HJ, Garson AD, Sorkin GC. , et al. Combined use of covered stent and flow diversion to seal iatrogenic carotid injury with vessel preservation during transsphenoidal endoscopic resection of clival tumor. Surg Neurol Int 2014; 5: 81
    PubMedGoogle Scholar
  • 18 Hoit DA, Schirmer CM, Malek AM. Stent graft treatment of cerebrovascular wall defects: intermediate-term clinical and angiographic results. Neurosurgery 2008; 62 (05) (Suppl. 02) ONS380-ONS388 ; discussion ONS388–ONS389
    PubMedGoogle Scholar
  • 19 Wang C, Xie X, You C. , et al. Placement of covered stents for the treatment of direct carotid cavernous fistulas. AJNR Am J Neuroradiol 2009; 30 (07) 1342-1346
    CrossrefPubMedGoogle Scholar
  • 20 Li J, Lan ZG, Xie XD, You C, He M. Traumatic carotid-cavernous fistulas treated with covered stents: experience of 12 cases. World Neurosurg 2010; 73 (05) 514-519
    CrossrefPubMedGoogle Scholar
  • 21 La Tessa G, Pasqualetto L, Catalano G. , et al. Traumatic carotid cavernous fistula: failure of endovascular treatment with two stent-grafts. Interv Neuroradiol 2005; 11 (04) 369-375
    CrossrefPubMedGoogle Scholar
  • 22 Morón FE, Klucznik RP, Mawad ME, Strother CM. Endovascular treatment of high-flow carotid cavernous fistulas by stent-assisted coil placement. AJNR Am J Neuroradiol 2005; 26 (06) 1399-1404
    PubMedGoogle Scholar
  • 23 Tiewei Q, Ali A, Shaolei G. , et al. Carotid cavernous fistulas treated by endovascular covered stent grafts with follow-up results. Br J Neurosurg 2010; 24 (04) 435-440
    CrossrefPubMedGoogle Scholar
  • 24 Ding H, He M, You C, Deng L. Application of endovascular covered stent for treating vertebral dissecting aneurysm and carotid-cavernous fistula [in Chinese]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2009; 23 (02) 215-218
    PubMedGoogle Scholar
  • 25 Park YS, Jung JY, Ahn JY, Kim DJ, Kim SH. Emergency endovascular stent graft and coil placement for internal carotid artery injury during transsphenoidal surgery. Surg Neurol 2009; 72 (06) 741-746
    CrossrefPubMedGoogle Scholar
  • 26 Guo H, Yin Q, Liu P, Guan N, Huo X, Li Y. Focus on the target: angiographic features of the fistulous point and prognosis of transvenous embolization of cavernous sinus dural arteriovenous fistula. Interv Neuroradiol 2018; 24 (02) 197-205
    CrossrefPubMedGoogle Scholar
  • 27 Kirsch M, Henkes H, Liebig T. , et al. Endovascular management of dural carotid-cavernous sinus fistulas in 141 patients. Neuroradiology 2006; 48 (07) 486-490
    CrossrefPubMedGoogle Scholar
  • 28 De Renzis A, Nappini S, Consoli A. , et al. Balloon-assisted coiling of the cavernous sinus to treat direct carotid cavernous fistula. A single center experience of 13 consecutive patients. Interv Neuroradiol 2013; 19 (03) 344-352
    CrossrefPubMedGoogle Scholar
  • 29 Wendl CM, Henkes H, Martinez Moreno R, Ganslandt O, Bäzner H, Aguilar Pérez M. Direct carotid cavernous sinus fistulae: vessel reconstruction using flow-diverting implants. Clin Neuroradiol 2017; 27 (04) 493-501
    CrossrefPubMedGoogle Scholar
  • 30 Roy AK, Grossberg JA, Osbun JW. , et al. Carotid cavernous fistula after Pipeline placement: a single-center experience and review of the literature. J Neurointerv Surg 2017; 9 (02) 152-158
    CrossrefPubMedGoogle Scholar
  • 31 Wang W, Li YD, Li MH. , et al. Endovascular treatment of post-traumatic direct carotid-cavernous fistulas: a single-center experience. J Clin Neurosci 2011; 18 (01) 24-28
    CrossrefPubMedGoogle Scholar
  • 32 Kisser A, Kirisits A. Endovascular embolization of unruptured intracranial aneurysms with flow diverters. Decision Support Document No. 83. Vienna, Austria: Ludwig Boltzmann Institute for Health Technology Assessment; 2015
    Google Scholar
  • 33 Aydin K, Arat A, Sencer S. , et al. Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents. J Neurointerv Surg 2015; 7 (03) 202-209
    CrossrefPubMedGoogle Scholar
  • 34 Cohen JE, Gomori JM, Leker RR, Spektor S, Abu El Hassan H, Itshayek E. Stent and flow diverter assisted treatment of acutely ruptured brain aneurysms. J Neurointerv Surg 2018; 10 (09) 851-858
    CrossrefPubMedGoogle Scholar
  • 35 Rohr A, Alfke K, Dörner L, Bartsch T, Stingele R, Jansen O. Treatment of carotid artery aneurysms with covered stents [in German]. RoFo Fortschr Geb Rontgenstr Nuklearmed 2007; 179 (10) 1048-1054
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Ding L, Gu Z, Wang R, Li Y, Fang Y. Acute stent thrombosis after stent-assisted coiling in an intracranial aneurysm patient carrying two reduced-function CYP2C19 alleles: a case report. Medicine (Baltimore) 2017; 96 (47) e8920
    PubMedGoogle Scholar
  • 37 Kahyaoglu M, Velioglu M, Gecmen C, Kalayci A, Cakmak EO, Izgi İA. Acute carotid stent thrombosis. J Cardiovasc Thorac Res 2018; 10 (04) 243-245
    CrossrefPubMedGoogle Scholar
  • 38 Lin LM, Jiang B, Campos JK. , et al. Abciximab (ReoPro) dosing strategy for the management of acute intraprocedural thromboembolic complications during pipeline flow diversion treatment of intracranial aneurysms. Intervent Neurol 2018; 7 (05) 218-232
    CrossrefPubMedGoogle Scholar
  • 39 Duncan IC, Fourie PA. Initial experience with intracranial stent-graft use. Technical notes. Interv Neuroradiol 2005; 11 (02) 131-139
    PubMedGoogle Scholar
  • 40 Cho KC, Seo DH, Choe IS, Park SC. Cerebral hemorrhage after endovascular treatment of bilateral traumatic carotid cavernous fistulae with covered stents. J Korean Neurosurg Soc 2011; 50 (02) 126-129
    CrossrefPubMedGoogle Scholar