Individualized endovascular treatment of high-grade traumatic vertebral artery injury

【作者】 梅其勇； 白如林； 黄承光； 陈怀瑞； 齐向前； 吕立权； 董艳； 于明琨； 孙克华； 侯立军；

【机构】 上海长征医院神经外科 上海市神经外科研究所 中国人民解放军神经外科研究所；

【摘要】 Background:Traumatic vertebral artery injury(TVAI) is associated with craniocervical trauma which can lead to potentially fatal posterior circulation stroke.It presents a clinical challenge since it is hard to detect and there are no widely accepted guidelines on diagnosis and management.High-grade TVAI is more difficult to treat and no consensus has been reached yet.Methods:We performed a single-center,long-term,therapeutic study involving 272 patients with craniocervical injury at our department,eleven of which were diagnosed with high-grade TVAI.Individualized endovascular treatments were performed to these patients based upon their hemodynamic and morphological characteristics of the injured vertebral artery.Follow-up were conducted by angiography at 2 weeks,3 months,6 months postoperatively,and then annually after intervention.Results:Ten vertebral pseudoaneurysm and one arteriovenous fistula were confirmed by angiography.All the participants symptoms of neurological deficits disappeared or were significantly alleviated gradually,and no new symptom was found after endovascular treatment.The follow-up angiography of ten patients with pseudoaneurysm showed normal shape of vertebral artery with no stenosis or aneurysms,and the angiographic result of the patient with AVF presented successful embolization in the proximal vertebral artery fistula with no progression or new stenosis.Their scores of modified Rankin Scale(mRS) were also satisfactory.Conclusions:Application of individualized endovascular therapy in high-grade TVAI is safe,technically feasible and clinically effective,but there is no comparison between endovascular management and other managements because no randomized trials can be carried out currently.更多还原

【Abstract】 Background:Traumatic vertebral artery injury(TVAI) is associated with craniocervical trauma which can lead to potentially fatal posterior circulation stroke.It presents a clinical challenge since it is hard to detect and there are no widely accepted guidelines on diagnosis and management.High-grade TVAI is more difficult to treat and no consensus has been reached yet.Methods:We performed a single-center,long-term,therapeutic study involving 272 patients with craniocervical injury at our department,eleven of which were diagnosed with high-grade TVAI.Individualized endovascular treatments were performed to these patients based upon their hemodynamic and morphological characteristics of the injured vertebral artery.Follow-up were conducted by angiography at 2 weeks,3 months,6 months postoperatively,and then annually after intervention.Results:Ten vertebral pseudoaneurysm and one arteriovenous fistula were confirmed by angiography.All the participants symptoms of neurological deficits disappeared or were significantly alleviated gradually,and no new symptom was found after endovascular treatment.The follow-up angiography of ten patients with pseudoaneurysm showed normal shape of vertebral artery with no stenosis or aneurysms,and the angiographic result of the patient with AVF presented successful embolization in the proximal vertebral artery fistula with no progression or new stenosis.Their scores of modified Rankin Scale(mRS) were also satisfactory.Conclusions:Application of individualized endovascular therapy in high-grade TVAI is safe,technically feasible and clinically effective,but there is no comparison between endovascular management and other managements because no randomized trials can be carried out currently.更多还原