Hyperacute Carotid Artery Occlusion with Insufficient Collateral Flow: A Case Report Illustrating a Largely Ignored Life-Threatening Traumatic Cerebrovascular Injury

Abstract

\n Background: Traumatic cerebrovascular injuries (TCI) are rare diseases, with the incidence of 0.18%-1.5% among trauma patients. Among TCI, ischemic TCI is more likely to be ignored when compared with hemorrhagic TCI. However severe ischemic TCI such as acute total occlusion of carotid artery may also be life-threatening especially when without sufficient collateral flow.Case presentation: We report an 18-year-old male patient in cardiopulmonary arrest was transported to our hospital 13 minutes after falling from a 60-feet tall building. After physical examination, an acute right internal carotid arteries (ICA) occlusion was suspected and be further confirmed by digital subtraction angiography (DSA) examination. Subsequent angiograms showed bilateral traumatic dissections of the ICA with complete occlusion of the right ICA just distal to the carotid bifurcation, and severe narrowing of the left ICA. Two covered stents were implanted to reconstruct bilateral ICAs followed by proximal occlusion of ruptured ECA branches using coils. The patient’s blood pressure gradually improved after the procedure. Dual antiplatelet therapy was initiated on the second day. Six-month Follow-up CTAs indicated that bilateral ICAs were well reconstructed, and the patient had a mRS score of 1 at six-month follow-up. Conclusion: TCI may achieve very good clinical outcome if they were diagnosed and properly treated via timely endovascular intervention.