Bilateral internal carotid and vertebral artery dissection after a horse-riding injury.
Abstract: Blunt cerebrovascular injuries, defined as blunt injuries to the internal carotid or vertebral arteries, are uncommon and usually occur in victims of high-speed deceleration motor vehicle crashes. A blunt cerebrovascular injury after an equestrian accident is an extremely unusual presentation. In recent years, advances in screening and treatment with pharmacologic anticoagulation before the onset of neurologic symptoms have improved outcomes for these patients. Endovascular stenting and embolization, although unproven, offer a new potential approach for these complex injuries. We present a unique case of four-vessel blunt cerebrovascular injuries after a horse-riding injury that required multidisciplinary management.
Copyright © 2010. Published by Mosby, Inc.
Publication Date: 2010-10-05 PubMed ID: 20888534DOI: 10.1016/j.jvs.2010.05.065Google Scholar: Lookup
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Summary
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The research article discusses a rare case of blunt cerebrovascular injuries, affecting both the internal carotid and vertebral arteries, in a patient after a horse-riding accident, and the multidisciplinary approach used for its management.
Research Context and Objective
- The study begins by outlining that blunt cerebrovascular injuries (BCVI), defined as blunt injuries to the internal carotid or vertebral arteries, are relatively uncommon. While they are typically seen following high-speed deceleration motor vehicle accidents, one occurring as a result of an equestrian accident is highly unusual.
- The primary objective of the study was to discuss this unusual presentation and the novel approach to managing this type of injury in the case of a horse-riding accident involving four-vessel BCVI.
Methods and Treatment Approaches
- Recent developments in screening and treatment options for BCVI, as mentioned in the article, have led to better outcomes for afflicted patients. Specifically, pharmacologic anticoagulation, a treatment method involving the use of drugs to prevent blood clots, can be applied before the onset of neurologic symptoms to preserve patient health.
- In addition, endovascular stenting and embolization are identified as potential treatment options for these complex injuries. While these methods still are not proven completely effective, they serve as hopeful future avenues for treatment. Stenting helps keep arteries open while embolization procedures aim to stop bleeding.
- The combination of these advanced treatment options represents an overall multidisciplinary approach to managing these injuries. This refers to the integration of knowledge and methods from several disciplines to adequately address the complex nature of BCVI.
Key Findings
- The primary input provided through this study is the unique case presentation and the identification of potential treatment methods for such rare injuries.
- The authors hope that the discussion of this unique case will contribute to further exploration and understanding in the field, which may in turn lead to more standardized management techniques and improved patient outcomes.
Cite This Article
APA
Keilani ZM, Berne JD, Agko M.
(2010).
Bilateral internal carotid and vertebral artery dissection after a horse-riding injury.
J Vasc Surg, 52(4), 1052-1057.
https://doi.org/10.1016/j.jvs.2010.05.065 Publication
Researcher Affiliations
- Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA 70121, USA. zkeilani@ochsner.org
MeSH Terms
- Animals
- Anticoagulants / therapeutic use
- Athletic Injuries / complications
- Athletic Injuries / diagnostic imaging
- Athletic Injuries / therapy
- Brain Ischemia / etiology
- Carotid Artery, Internal, Dissection / diagnostic imaging
- Carotid Artery, Internal, Dissection / etiology
- Carotid Artery, Internal, Dissection / therapy
- Combined Modality Therapy
- Embolization, Therapeutic
- Female
- Horses
- Humans
- Magnetic Resonance Angiography
- Middle Aged
- Platelet Aggregation Inhibitors / therapeutic use
- Stents
- Stroke / etiology
- Thoracic Injuries / complications
- Thoracic Injuries / diagnostic imaging
- Thoracic Injuries / therapy
- Tomography, X-Ray Computed
- Treatment Outcome
- Vertebral Artery Dissection / diagnostic imaging
- Vertebral Artery Dissection / etiology
- Vertebral Artery Dissection / therapy
- Wounds, Nonpenetrating / complications
- Wounds, Nonpenetrating / diagnostic imaging
- Wounds, Nonpenetrating / therapy
Citations
This article has been cited 12 times.- Maiese A, Frati P, Manetti AC, De Matteis A, Di Paolo M, La Russa R, Turillazzi E, Frati A, Fineschi V. Traumatic Internal Carotid Artery Injuries: Do We Need a Screening Strategy? Literature Review, Case Report, and Forensic Evaluation.. Curr Neuropharmacol 2022 Aug 3;20(9):1752-1773.
- Liao M, Chen X, Chen H, Wang Y, Zeng J, Fan Y. Stent-Assisted Angioplasty in Spontaneous Bilateral Extracranial Internal Carotid Artery Dissection.. Front Neurol 2020;11:582253.
- Ishigami D, Ota T. Spontaneous Bilateral Cervical Internal Carotid Artery Dissection Treated with Simultaneous Bilateral Carotid Artery Stenting: A Case Report.. NMC Case Rep J 2019 Aug;6(3):71-74.
- Schlemm L, Nolte CH, Engelter ST, Endres M, Ebinger M. Cervical artery dissection after sports - An analytical evaluation of 190 published cases.. Eur Stroke J 2017 Dec;2(4):335-345.
- Ariyada K, Shibahashi K, Hoda H, Watanabe S, Nishida M, Hanakawa K, Murao M. Bilateral Internal Carotid and Left Vertebral Artery Dissection after Blunt Trauma: A Case Report and Literature Review.. Neurol Med Chir (Tokyo) 2019 Apr 15;59(4):154-161.
- Saw AE, McIntosh AS, Kountouris A, Newman P, Gaida JE. Vertebral Artery Dissection in Sport: A Systematic Review.. Sports Med 2019 Apr;49(4):553-564.
- Avila SV, Noy BV, Karsy M, Alexander M, Rolston JD. Bilateral blunt cerebrovascular injury resulting in direct carotid-cavernous fistulae: A case report and review of the literature.. Surg Neurol Int 2018;9:229.
- Coss C, Jones J. Bilateral Carotid and Vertebral Artery Dissection from Blunt Trauma.. Case Rep Emerg Med 2018;2018:1919034.
- Efeoglu M, Akoglu H, Akoglu T, Eroglu SE, Onur OE, Denizbasi A. Spinal Trauma is Never without Sin: A Tetraplegia Patient Presented Without any Symptoms.. Turk J Emerg Med 2014 Dec;14(4):188-92.
- Pröscholdt F, Heining S, Powerski M, Nolte CH, Ertel W. Traumatic Dissection of Four Brain-Supplying Arteries without Neurologic Deficit.. Global Spine J 2014 Aug;4(3):187-90.
- Gapsis BC, Ranjit RU, Malavade S, Carey A, Murtagh R, Drucker MD, Pavan PR. Spontaneous resolution of ophthalmologic symptoms following bilateral traumatic carotid cavernous fistulae.. Digit J Ophthalmol 2013;19(2):33-8.
- Kishi S, Kanaji K, Doi T, Matsumura T. A case of traumatic intracranial vertebral artery injury presenting with life-threatening symptoms.. Int Med Case Rep J 2012;5:23-8.
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