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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; 20:1752-1773. [PMID: 34254918 PMCID: PMC9881067 DOI: 10.2174/1570159x19666210712125929] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/05/2021] [Accepted: 06/01/2021] [Indexed: 11/22/2022] Open
Abstract
Internal carotid artery dissection (ICAD) represents the cause of ictus cerebri in about 20% of all cases of cerebral infarction among the young adult population. ICAD could involve the extracranial and intracranial internal carotid artery (ICA). It could be spontaneous (SICAD) or traumatic (TICAD). It has been estimated that carotid injuries could complicate the 0,32% of cases of general blunt trauma and the percentage seems to be higher in cases of severe multiple traumas. TICAD is diagnosed when neurological symptoms have already occurred, and it could have devastating consequences, from permanent neurological impairment to death. Thus, even if it is a rare condition, a prompt diagnosis is essential. There are no specific guidelines regarding TICAD screening. Nevertheless, TICAD should be taken into consideration when a young adult or middle-aged patient presents after severe blunt trauma. Understanding which kind of traumatic event is most associated with TICAD could help clinicians to direct their diagnostic process. Herein, a review of the literature concerning TICAD has been carried out to highlight its correlation with specific traumatic events. TICAD is mostly correlated to motor vehicle accidents (94/227), specifically to car accidents (39/94), and to direct or indirect head and cervical trauma (76/227). As well, a case report is presented to discuss TICAD forensic implications.
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Affiliation(s)
- Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy; ,IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy;
| | - Paola Frati
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Alice Chiara Manetti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Marco Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Raffaele La Russa
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy;
| | - Emanuela Turillazzi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126Pisa (PI), Italy;
| | - Alessandro Frati
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy
| | - Vittorio Fineschi
- IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli (IS), Italy; ,Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy; ,Address correspondence to this author at the Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome (RM), Italy; E-mail:
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Amadasi A, Franceschetti L, Crudele GDL, Roselli MR, Gentile G, Zoja R. The hidden aspect of carotid lesions in traffic accidents: A little-known phenomenon. J Forensic Leg Med 2022; 86:102316. [PMID: 35021120 DOI: 10.1016/j.jflm.2022.102316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 11/17/2022]
Abstract
Vascular injuries that occur during traffic accidents are a commonly neglected aspect that can add more detail to the framework of a case. In this study, we analysed a case series of 150 traffic accidents, 39 of which were marked by microscopically identifiable vascular lesions. The purpose was to identify the presence of carotid injuries in individuals who died due to traffic accidents and had nonpenetrating trauma of the neck. We focused on the discrepancies regarding the macroscopical aspect and the histology and demonstrated how histological analysis of the carotids in cases of trauma can reveal injuries that are attributable to the trauma itself. We conducted a histological analysis of the lesions to describe their distribution and type and investigate potential correlations. The study offers insight on how to examine road accidents that involve traumatic injury of the carotid arteries. Indeed the main task of the forensic pathologist in the case of death is to establish the existence of a causal relationship between the micro- or macroscopic alterations observed in the autopsy and the traumatic event that led to the death of the subject. Thus, further morphological elements were provided to the forensic practitioners that may reveal injuries attributable to the trauma itself and should be evaluated in cases of trauma in traffic accidents.
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Affiliation(s)
- Alberto Amadasi
- Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Lorenzo Franceschetti
- Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | | | - Maria Rosa Roselli
- Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Guendalina Gentile
- Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Riccardo Zoja
- Institute of Legal Medicine, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Shimizu T, Maruo T, Nakamura H, Ushio Y, Kishima H. Multiple stenting using anchoring technique with balloon guiding catheter for common carotid artery dissection after aortic arch replacement: A case report. Int J Surg Case Rep 2021; 81:105748. [PMID: 33756166 PMCID: PMC8020436 DOI: 10.1016/j.ijscr.2021.105748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 11/25/2022] Open
Abstract
The treatment for CCA dissection after aortic arch replacement is challenging. Anchoring technique using BGC is useful to resolve the difficulty by the alteration of anatomy and lack of elasticity of vascular grafts. Multiple stenting through vascular grafts was highly tolerable and achieved the excellent long-term outcome.
Introduction and importance Common carotid artery (CCA) dissection is a minor complication during aortic arch replacement (AAR). Although endovascular treatment can be considered for symptomatic CCA dissection despite internal therapy, no report has mentioned about carotid stenting for CCA dissection after vascular graft replacement. Case presentation The patient was a 68-year-old man presented with recurrent transient right hemiparesis. CECT and arteriography showed the progressive CCA dissection associated with AAR and decreased cerebral blood flow. MRI showed no evidence of infarction. Epilepsy, electrolyte abnormalities, hypoglycemia, spinal cord disease were considered as differential diagnoses of transient paralysis, but all were negative. Considering these findings, we diagnosed the patient with transient ischemic attacks (TIAs) caused by CCA dissection. He was treated with multiple stents deployed through vascular grafts using anchoring technique with balloon guiding catheter. Angiography demonstrated reconstitution of the CCA and internal carotid artery 1.5 years after the intervention, and no further TIAs were observed. MRI scan showed no evidence of infarction. Clinical discussion After AAR, the alteration of anatomy and lack of elasticity of vascular grafts make it quite difficult to access lesions. The adoption of a distal access catheter (DAC) and balloon inflation of a guiding catheter (BGC) are useful approaches. Conclusion To our knowledge, this is the first case report of successful multiple carotid stenting through vascular grafts for the treatment of CCA dissection. The main take-away lessons are the following three. The treatment for CCA dissection after aortic arch replacement is challenging. Anchoring technique using BGC is useful to resolve the difficulty by the alteration of anatomy and lack of elasticity of vascular grafts. Multiple stenting through vascular grafts was highly tolerable and achieved the excellent long-term outcome.
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Affiliation(s)
- Takeshi Shimizu
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, Japan; Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Tomoyuki Maruo
- Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, Japan.
| | - Hajime Nakamura
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yukitaka Ushio
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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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. [PMID: 30568844 PMCID: PMC6262944 DOI: 10.4103/sni.sni_210_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/10/2018] [Indexed: 12/14/2022] Open
Abstract
Background Bilateral blunt cerebrovascular injury (BCVI) has been documented in 32 patients in the English-language literature and bilateral carotid-cavernous fistulae (CCFs) have been reported in only 1 patient. Here, we present a case of severe, unexpected bilateral BCVI with bilateral direct CCF and review the literature of BCVI, particularly cases of bilateral injury. Case Description A 65-year-old woman with episodic bradycardia presented after a motor vehicle accident. On arrival, she had a Glasgow Coma Scale of 3T and progressive dilation of her right pupil. Computed tomography imaging showed a 1.8-cm right epidural hematoma (EDH) with 6 mm of right-to-left shift. No acute skull-base fracture or injury in the area of the carotid canal was noted. The patient was treated with 3% hypertonic saline and mannitol before being taken to the operating room for emergent decompression of the hematoma. Although the patient initially presented with an EDH, significant intraoperative hemorrhage was identified during surgical evacuation and later confirmed as bilateral direct CCFs during angiographic evaluation. Because of the patient's devastating injuries, life-extending measures were not continued and the patient died. Conclusions A review of the literature indicates that bilateral CCFs are rare, having been reported only once previously. As this case demonstrates, CCFs may occur in high-energy injuries and should be considered even if the patient does not meet traditional screening criteria.
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Affiliation(s)
- Stephanie V Avila
- Department of Neurobiology and Anatomy, Clinical Neurosciences Center, Salt Lake City, Utah, USA
| | - Brooke Van Noy
- Department of Neurobiology and Anatomy, Clinical Neurosciences Center, Salt Lake City, Utah, USA
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, Salt Lake City, Utah, USA
| | - Matthew Alexander
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - John D Rolston
- Department of Neurosurgery, Clinical Neurosciences Center, Salt Lake City, Utah, USA
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Kil JS, Lee MK, Eom KS. Common Carotid Artery Dissection in Multiple Extracranial Injury: A Case Report. Korean J Neurotrauma 2018; 14:28-31. [PMID: 29774196 PMCID: PMC5949520 DOI: 10.13004/kjnt.2018.14.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/17/2018] [Accepted: 03/27/2018] [Indexed: 11/15/2022] Open
Abstract
Traumatic common carotid artery dissection (CCAD) is rare. To our knowledge, only 14 case reports have described traumatic CCAD previously. Here, we report a case of CCAD in a patient with severe trauma. A 50-year-old man was lying on the road after drinking alcohol when a car drove over him. Computed tomography (CT) revealed multiple rib fractures with hemopneumothorax, lung contusion, flail chest, large amount of hematoma with bladder rupture, and fractures on the C6 spinous process, sacral ala, iliac bone, and pubic ramus. Repair of the bladder rupture, exploratory thoracotomy, and open reduction of multiple rib fractures were performed. Right side hemiparesis was observed on hospital day 4. Brain CT showed a large acute left middle cerebral artery infarction. CT angiography showed focal carotid dissection at the left common carotid artery with intimal flap. The CCAD was located at the C6 level. Clexane (enoxaparin sodium) treatment was initiated. An abdominal CT scan revealed a huge retroperitoneal hematoma and increased amount of hematoma in the prevesical and perivesical space, 10 days later. The patient died two days later. Although traumatic CCAD is rare, this case report provides useful information for trauma surgeons regarding the treatment and diagnosis of similar cases.
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Affiliation(s)
- Jin Sang Kil
- Department of Neurosurgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Mi Kyung Lee
- Department of Thoracic and Cardiovascular Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Ki Seong Eom
- Department of Neurosurgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
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Janczak D, Ziomek A, Lesniak M, Malinowski M, Pormanczuk K, Janczak D, Dorobisz T, Chabowski M. The endovascular emergency treatment of an acute carotid artery dissection after Krav Maga training—a case report. HONG KONG J EMERG ME 2017. [DOI: 10.1177/1024907917745232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Carotid artery dissection accounts for 20%–30% of all ischemic strokes in young patients aged <50 years. Recent guidelines on carotid disease management do not differentiate between traumatic and spontaneous dissection. We present a case of a 36-year-old male patient with the right internal carotid artery dissection treated with two XACT Abbot 6–8 mm × 40 mm stents placement after he was strangled during Krav Maga training. It is the most effective way to prevent the imminent stroke in the penumbral region. The safety and outcome of stent placement in internal carotid artery dissection remains unclear and further randomized trials are needed.
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Affiliation(s)
- Dariusz Janczak
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Surgical Procedures, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Ziomek
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Surgical Procedures, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Michal Lesniak
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Surgical Procedures, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Maciej Malinowski
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Surgical Procedures, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Kornel Pormanczuk
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Surgical Procedures, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Dawid Janczak
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Oncology and Palliative Care, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Tadeusz Dorobisz
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Oncology and Palliative Care, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Mariusz Chabowski
- Department of Surgery, 4th Military Teaching Hospital, Wroclaw, Poland
- Division of Surgical Procedures, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
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Chiba F, Makino Y, Motomura A, Inokuchi G, Ishii N, Torimitsu S, Sakuma A, Nagasawa S, Saito H, Yajima D, Hayakawa M, Iwase H. Bilateral middle cerebral artery infarction associated with traumatic common carotid artery dissection: a case report and review of literature. Forensic Sci Int 2014; 236:e1-4. [PMID: 24480785 DOI: 10.1016/j.forsciint.2014.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 12/26/2013] [Accepted: 01/03/2014] [Indexed: 01/03/2023]
Abstract
Traumatic common carotid artery dissection is very rare, and although it is associated with mild symptoms, it can sometimes be fatal. Therefore, careful examination of common carotid artery dissection and additional pathological examination as appropriate are important during the autopsy of traumatic death patients. A 60-year-old previously healthy drunken woman was run over. She had remained unconscious shortly after the accident, and 15 h later, emerging bilateral cerebral infarction was confirmed using brain computed tomography. Despite conservative management, she died 4 days after the injury due to multiple chest traumas and broad cerebral infarction. A medico-legal autopsy was conducted. According to the autopsy results, microscopically identified common carotid artery dissections with thrombus formation were considered the cause of infarction. In the present case, macroscopic common carotid artery lesions were relatively mild, and this made diagnosis difficult. However, the correct diagnosis was achieved by a combined analysis of the antemortem images and autopsy results. Thus, in such cases, a combined comprehensive analysis of autopsy results and antemortem clinical images is important to determine the exact cause of death.
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Affiliation(s)
- Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan.
| | - Yohsuke Makino
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan; Department of Radiology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan
| | - Ayumi Motomura
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan
| | - Namiko Ishii
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan
| | - Ayaka Sakuma
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan
| | - Sayaka Nagasawa
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan
| | - Hisako Saito
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan
| | - Mutsumi Hayakawa
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba Prefecture 260-8670, Japan
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Severe brain damage after punitive training technique with a choke chain collar in a German shepherd dog. J Vet Behav 2013. [DOI: 10.1016/j.jveb.2013.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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