Obeng-Gyasi Barnabas, Young Kailah, Wilmes Danielle, Blackwell Matthew P, Tobin Matthew K, Bohnstedt Bradley N
Indiana University School of Medicine, Department of Neurological Surgery, 355W 15th St, Suite 5100, Indianapolis, IN 46202, USA.
Indiana University School of Medicine, Department of Neurological Surgery, 355W 15th St, Suite 5100, Indianapolis, IN 46202, USA.
J Stroke Cerebrovasc Dis. 2025 Jul;34(7):108307. doi: 10.1016/j.jstrokecerebrovasdis.2025.108307. Epub 2025 Apr 23.
Grade 3 blunt cerebrovascular injuries (BCVIs), also known as pseudoaneurysms, are characterized by arterial wall injury forming a sac-like structure, which can sometimes be associated with stenosis and poses a substantial risk of ischemic stroke. This study evaluates the outcomes of traumatic Grade 3 internal carotid artery injuries treated at a single institution.
A retrospective cohort study was conducted on 33 patients with Grade 3 carotid dissections treated between 2015 and 2022. Primary outcomes included stenosis progression, pseudoaneurysm status, and stroke occurrence.
At final imaging, 90.9 % of stenoses had resolved or improved, while 9.1 % remained unchanged or worsened. For pseudoaneurysms, 61 % had resolved or improved, while 39 % remained stable or worsened. Two patients (6.1 %) experienced strokes despite antiplatelet therapy, with one occurring early and one delayed. The majority (84.8 %) received conservative medical management, with only 9.1 % undergoing endovascular treatment.
Grade 3 carotid dissections have variable outcomes, with most improving or resolving. However, the persistent risk of stroke and pseudoaneurysm progression emphasizes the need for vigilant long-term monitoring and reconsideration of optimal management strategies, particularly regarding the role of antiplatelet therapy and endovascular intervention.
3级钝性脑血管损伤（BCVIs），也称为假性动脉瘤，其特征是动脉壁损伤形成囊状结构，有时可能与狭窄相关，并存在缺血性中风的重大风险。本研究评估了在单一机构治疗的创伤性3级颈内动脉损伤的结果。
对2015年至2022年间治疗的33例3级颈动脉夹层患者进行了回顾性队列研究。主要结果包括狭窄进展、假性动脉瘤状态和中风发生情况。
在最终成像时，90.9%的狭窄已缓解或改善，而9.1%保持不变或恶化。对于假性动脉瘤，61%已缓解或改善，而39%保持稳定或恶化。尽管进行了抗血小板治疗，仍有2例患者（6.1%）发生中风，1例为早期中风，1例为延迟中风。大多数患者（84.8%）接受了保守药物治疗，只有9.1%的患者接受了血管内治疗。
3级颈动脉夹层的结果各不相同，大多数患者病情改善或缓解。然而，中风和假性动脉瘤进展的持续风险强调了长期密切监测和重新考虑最佳管理策略的必要性，特别是关于抗血小板治疗和血管内干预的作用。
