Common carotid artery (CCA) dissection is a rare emergency condition. Early diagnosis of these cases is important to prevent the ischemic emergencies. We presented a CCA dissection case, who was admitted to the hospital after taken out from under rubble with satisfactory outcome.
Carotid Artery Injuries ; diagnosis ; therapy ; Carotid Artery, Common ; Humans ; Male ; Middle Aged

Aneurysm, False/etiology* ; Carotid Artery Injuries/therapy* ; Carotid Artery, Internal ; Embolization, Therapeutic ; Epistaxis/etiology* ; Humans

PURPOSE: To explore the diagnosis and treatment of traumatic external carotid branch pseudoaneurysms. METHODS: Eleven cases of traumatic external carotid artery branch pseudoaneurysms were admitted in our hospital. Digital subtraction angiography was performed in all patients. It revealed that the pseudoaneurysms originated from the internal maxillary artery in 5 cases, superficial temporal artery in 5 cases and occipital artery in 1 case. Five cases of internal maxillary artery pseudoaneurysms and 2 cases of superficial temporal artery pseudoaneurysms were treated by embolization; the other 3 cases were surgically resected. RESULTS: Complete cessation of nasal bleeding was achieved in all the 5 pseudoaneurysms of internal maxillary artery after the endovascular therapies. Scalp bleeding stopped and scalp defect healed up in 2 patients with superficial temporal artery pseudoaneurysms treated by interventional therapy. All patients were followed up for 0.5-2.0 years without recurrence of nosebleed and scalp lump. CONCLUSION For patients with repeated severe epistaxis after craniocerebral injury, digital subtraction angiography should be performed as soon as possible to confirm traumatic pseudoaneurysm. Endovascular therapy is an effective method for traumatic internal maxillary artery pseudoaneurysms. For patients with scalp injuries and pulsatile lumps, further examinations including digital subtraction angiography should be performed to confirm the diagnosis. Surgical treatment or endovascular therapy for scalp traumatic pseudoaneurysm is effective.
Aneurysm, False/therapy* ; Angiography, Digital Subtraction ; Carotid Artery Injuries/therapy* ; Carotid Artery, External/diagnostic imaging* ; Embolization, Therapeutic ; Humans

Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of traumarelated extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpet-rosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed.
Adult ; Carotid Artery Injuries/complications ; Carotid Artery, Internal, Dissection/etiology/radiography/*therapy ; Case Report ; Cerebral Angiography ; Human ; Male ; *Stents

OBJECTIVE: To discuss the clinical features, diagnosis and treatment of traumatic pseudoaneurysm. METHOD: We report 4 unusual cases of traumatic Pseudoaneurysms of the artery of head and neck. The data of the 4 cases was analysed retrospectively. RESULT: Four patients were with history of trauma and traumatic pseudoaneurysm were diagnosed by CT and DSA. Two of them accepted interventional vascular therapy, the others accepted surgical operation. Both methods are safe and effective. CONCLUSION Traumatic pseudoaneurysms of the artery of head and neck are rare but potentially lethal. The diagnosis is not difficult. The interventional treatment should be the first choice if possible, while the surgical approach is another choice. Doctors should try to repair the arterial wall, to keep the artery patency and to decrease the unnecessary complications.
Adult ; Aneurysm, False ; therapy ; Carotid Arteries ; Carotid Artery, Common ; Female ; Humans ; Male ; Retrospective Studies ; Vertebral Artery ; injuries

Carotid Artery Injuries ; therapy ; Carotid-Cavernous Sinus Fistula ; therapy ; Embolization, Therapeutic ; methods ; Humans ; Male ; Middle Aged ; Stents

Carotid artery injury is a very rare, but life threatening complication that can occur during a transsphenoidal approach. We experienced one case of carotid artery injury during a transsphenoidal pituitary tumor surgery. The patient was immediately treated by a balloon occlusion and complete packing of the cavernous carotid artery using Guglielmi detachable coils (GDCs) and the rest of the tumor was removed after the carotid occlusion. The patient recovered without showing any neurological deficits.
Adult ; Carotid Artery Injuries/*therapy ; *Carotid Artery, Internal ; Case Report ; Emergencies ; Human ; Intraoperative Complications/*therapy ; Male ; Pituitary Neoplasms/*surgery ; Sphenoid Bone

PURPOSE: This study was designed to investigate whether vascular smooth muscle cells (VSMC) from the neointima showed any different response to antiproliferative agents, such as rapamycin or imatinib mesylate, compared to VSMCs from normal artery. MATERIALS AND METHODS: Intimal hyperplasia was made by carotid balloon in jury in male rats. Neointimal cells at 4 weeks after injury and normal VSMCs were extracted by enzymatic isolation method and cultured. Cell viability and proliferation were tested in VSMCs from injured left carotid artery and uninjured right carotid artery. Tests were repeated with rapamycin, imatinib mesylate or both in various concentrations. RESULTS: Rapamycin decreased cell viability only at a high concentration of 10(-5) M in uninjured VSMCs. Combined drugs decreased cell viability at a lower concentration of 10(-7) M in uninjured VSMCs, and at a higher concentration of 10(-5) M in neointimal cells. Overall, rapamycin showed cytocidal effects at a high concentration of 10(-5) M, whereas imatinib did not. Cell proliferation of neointima was significantly decreased along with the drug concentration. Cell proliferation of uninjured VSMCs was significantly decreased at higher drug concentrations. Combined drug therapy showed synergistic effects. Overall, neointimal cells are more susceptible to the antiproliferative effects of the drugs. CONCLUSION: Neointimal cells from the injured carotid artery are more susceptible to the antiproliferative effect of imatinib and rapamycin. Both drugs can be a used for the prevention of intimal hyperplasia, which could be investigated through further in vivo studies.
Animals ; Arteries ; Carotid Arteries ; Carotid Artery Injuries ; Cell Proliferation ; Cell Survival ; Drug Therapy ; Humans ; Hyperplasia ; Male ; Mesylates* ; Muscle, Smooth, Vascular* ; Neointima ; Rats ; Sirolimus* ; Imatinib Mesylate

Injury to the supraaortic artery is a rare event, with poor prognosis and high mortality. Improvement of the outcome may lie on the combination of several aspects, including better pre-hospital care, use of emergency cardiopulmonary bypass (CPB), improved surgical techniques and facilities, and advanced postoperative intensive care. Some researchers emphasized the importance of emergency CPB in the treatment and thought that it was responsible mainly for the improved outcome. However, there exists controversies about it. In this article, we reported that a patient with life-threatening hemorrhage due to traumatic transection of the left common carotid artery, who was admitted to our hospital in July 2003, was treated successfully with operations with help of emergency CPB and systemic hypothermia.
Accidents, Occupational ; Adult ; Anastomosis, Surgical ; Angiography ; methods ; Cardiopulmonary Bypass ; methods ; Carotid Artery Injuries ; diagnostic imaging ; surgery ; Carotid Artery, Common ; Combined Modality Therapy ; Follow-Up Studies ; Humans ; Injury Severity Score ; Male ; Risk Assessment ; Treatment Outcome ; Vascular Surgical Procedures ; methods

OBJECTIVE: To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudoaneurysms presenting as intractable epistaxis. MATERIALS AND METHODS: For 14 consecutive patients with traumatic pseudoaneurysm presenting as refractory epistaxes, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudoaneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (ICA); out of which, two were managed with detachable balloons, two with covered stents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. RESULTS: Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from ICA pseudoaneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. CONCLUSION: In patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudoaneurysms.
Adolescent ; Adult ; Aneurysm, False/radiography/*therapy ; Angiography, Digital Subtraction ; Angioplasty, Balloon ; Carotid Artery Injuries/radiography/*therapy ; Carotid Artery, Internal ; Diagnosis, Differential ; Embolization, Therapeutic ; Endovascular Procedures/*methods ; Epistaxis/radiography/*therapy ; Female ; Humans ; Male ; Maxillary Artery/*injuries ; Middle Aged ; Retrospective Studies ; Stents ; Tomography, X-Ray Computed ; Treatment Outcome