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Individualized endovascular treatment of high-grade traumatic vertebral artery injury

  • Clinical Article - Brain Injury
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Traumatic vertebral artery injury (TVAI) is associated with craniocervical trauma that 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, eleven of which were diagnosed with high-grade TVAI. Individualized endovascular treatments were performed on these patients based upon the hemodynamic and morphological characteristics of the injured vertebral artery. Postoperative angiography was conducted at 2 weeks, 3 months and 6 months, and then annually after intervention.

Results

Ten vertebral pseudoaneurysms and one arteriovenous fistula (AVF) were confirmed by postoperative angiography. All the participants’ neurological deficit symptoms disappeared or were significantly alleviated gradually, and no new symptoms were found after endovascular treatment. Follow-up angiography of the patients with pseudoaneurysms showed a normally shaped vertebral artery with no stenosis or aneurysms; the angiographic result of the patient with the AVF presented successful embolization in the proximal vertebral artery fistula with no progression or new stenosis. Their modified Rankin Scale (mRS) scores 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 management approaches because randomized trials cannot be carried out currently.

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Acknowledgment

Thanks to Prof. Ross Bullock for his encouragement and inspiration in our work, and thank the participants for their cooperation in our follow-up.

Conflicts of Interest

None.

Source of Funding

There is no source of funding.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Shanghai Changzheng Hospital, the Second Military Medical University, No 415, Fengyang road, Shanghai, China, 200003

    Qiyong Mei, Mingxing Sui, Rulin Bai, Chengguang Huang & Lijun Hou

  2. Worldwide medical centre of Huashan hospital, Fudan University, Shanghai, China

    Wenze Xiao

  3. Department of Orthopedics, Shanghai Changzheng Hospital, the Second Military Medical University, Shanghai, China

    Zhengwang Sun

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  1. Qiyong Mei
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  2. Mingxing Sui
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  7. Lijun Hou
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Corresponding author

Correspondence to Lijun Hou.

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Author Contribution statement

Qiyong Mei and Mingxing Sui contributed to literature search, data collection and writing. Wenze Xiao contributed to study design and critical revision of the manuscript. Zhengwang Sun contributed to data collection and follow up. Rulin Bai and Chengguang Huang contributed to data collection, technique support and critical revision. Lijun Hou and Qiyong Mei contributed to the development of the study design, data analysis, and interpretation. They were all involved in the development, reviewing, and revising of the manuscript.

Qiyong Mei, Mingxing Sui and Wenze Xiao contributed equally to this paper.

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Mei, Q., Sui, M., Xiao, W. et al. Individualized endovascular treatment of high-grade traumatic vertebral artery injury. Acta Neurochir 156, 1781–1788 (2014). https://doi.org/10.1007/s00701-014-2074-0

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  • DOI: https://doi.org/10.1007/s00701-014-2074-0

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