Endovascular Stenting for the Treatment of Traumatic Internal Carotid Injuries: Expanding Experience Joseph DuBose, MD, Gustavo Recinos, MD, Pedro G. R. Teixeira, MD, Kenji Inaba, MD, and Demetrios Demetriades, MD, PhD Background: The role of endovascu- lar techniques in the treatment of trau- matic vascular injuries, including injury to the internal carotid artery, continues to evolve. Despite growing experience with the usage of these techniques in the setting of artherosclerotic disease, published re- sults in traumatic carotid injuries remain sporadic and confined to case reports and case series. Methods: We conducted a review of the medical literature from 1990 to the present date using the Pubmed and OVID Medline databases to search for all re- ports documenting the use of endovascu- lar stenting for the treatment of carotid injuries. Thirty-one published reports were analyzed to abstract data regarding mechanism, location, and type of injury; use and type of anticoagulation used in conjunction with stenting; type and timing of radiographic and clinical follow-up; and radiographic and clinical outcomes. Results: The use of endovascular stenting for the treatment of internal ca- rotid injuries was reported for only 113 patients from 1994 to the present date. Stenting was most commonly used after a blunt mechanism of injury (77.0%). The injury types treated by stenting included pseudoaneurysm (60.2%), arteriovenous fistula (16.8%), dissection (14.2%), partial transection (4.4%), occlusion (2.7%), inti- mal flap (0.9%), and aneurysm (0.9%). Initial endovascular stent placement was successful in 76.1% of patients. Radio- graphic and clinical follow-up periods ranging from 2 weeks to 2 years revealed a follow-up patency of 79.6%. No stent- related mortalities were reported. New neurologic deficits after stent placement occurred in 3.5%. Conclusion: Endovascular treatment of traumatic internal carotid artery injury continues to evolve. Early results are en- couraging, but experience with this mo- dality and data on late follow-up are still very limited. A large prospective random- ized trial is warranted to further define the role of this treatment modality in the setting of trauma. Key Words: Trauma, Carotid injury, Stenting. J Trauma. 2008;65:1561–1566. T he management of traumatic injuries of the internal ca- rotid artery has traditionally required operative interven- tion. The surgical approach for carotid repair may be complex, particularly with base of skull lesions where ob- taining proximal and distal control may result in significant morbidity and mortality. 1 The emergence of endovascular techniques offers an alternative to traditional surgical management of select ca- rotid lesions. Initially designed for the treatment of intracra- nial and high extracranial lesions, endovascular stents have seen expanded use at other extracranial locations. Published experience to date, however, remains limited. Reports of successful endovascular treatment of traumatic internal ca- rotid injuries remain confined to case reports and small series documented in the medical literature. Our study was designed to summarize the experience to date with endovascular stent- ing for these injuries through a review of the available med- ical literature. METHODS We conducted a systematic review of the English-speaking medical literature using the PubMed (www.pubmed.gov, ac- cessed 25 August 07) service of the National Library of Medicine/National Institutes of Health and OVID Medline databases (Copyright © 2000 –2007 Ovid Technologies, Ver- sion: rel10.5.1) to identify all case reports carotid artery stenting after traumatic carotid artery injuries. A multidisci- plinary group of surgeons, intensivists, and biostatistician used the following criteria to select studies to be included for analysis: adequate information regarding mechanism, loca- tion, and type of injury; use and type of anticoagulation used in conjunction with stenting; type and timing of radiographic and clinical follow-up; radiographic and clinical outcomes. RESULTS Fifty-two published reports with endovascular stenting for the treatment of traumatic internal carotid injuries were identified. Twenty-one of these publications lacked sufficient information for inclusion and were excluded, leaving 31 published case reports or case series available for review over a time the study period time of 1994 to 2007. 2–32 Submitted for publication January 9, 2008. Accepted for publication May 14, 2008. Copyright © 2008 by Lippincott Williams & Wilkins From the Division of Trauma and Critical Care at the Los Angeles County, University of Southern California Medical Center, Los Angeles, California. Address for reprints: Joe DuBose, MD, 1200 North State Street, Room 10-750, Los Angeles, CA 9003-4525; email: jjd3c@yahoo.com. DOI: 10.1097/TA.0b013e31817fd954 Review Article The Journal of TRAUMA  Injury, Infection, and Critical Care Volume 65 • Number 6 1561