Endovascular reconstruction of iatrogenic internal carotid artery injury following endonasal surgery: a systematic revie
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REVIEW
Endovascular reconstruction of iatrogenic internal carotid artery injury following endonasal surgery: a systematic review Mohammad Ghorbani 1 Ebrahim Hejazian 6
&
Christoph J. Griessenauer 2,3
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Hamidreza Shojaei 4
&
Christoph Wipplinger 5
&
Received: 25 February 2020 / Revised: 30 July 2020 / Accepted: 24 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The objective of this study is to provide an update on endovascular treatments for iatrogenic internal carotid artery (ICA) injuries following endonasal surgery. A systematic review of the literature was performed by using Medline, Cochrane library, and Scopus from 1999 to 2019. We used a combination of the MeSH terms “internal carotid artery,” “iatrogenic disease,” and “endovascular procedure.” Twenty-six articles including 46 patients were identified for in this systematic review. The mean age of the patients was 49 years (CI: ± 4.2). The most common site of ICA injury was in cavernous segment (18 patients; 39%). The most common type of iatrogenic ICA injury was a traumatic pseudoaneurysm documented in 28 patients (60%). Endoluminal reconstruction was performed using covered stents in 28 patients, the Pipeline embolization device (PED) in 13 patients, the Surpass flow diverter device in three, the SILK flow diverter in one, and one case was treated using a combined approach of a covered stent and a PED. Flow diversion and covered stents resulted in a good clinical outcome in 94% and 89% of patients, respectively. This difference did not reach statistical significance (p = 1.0). Even though this systematic review was limited due to articles of small sample sizes and considerable heterogeneity, the results indicate that flow diverting devices and covered stents are good therapeutic options for endoluminal reconstruction of iatrogenic ICA injuries following endonasal surgery. Keywords Endovascular . Iatrogenic . Internal carotid artery . Trans-sphenoidal surgery
Background
* Hamidreza Shojaei [email protected] 1
Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
2
Department of Neurosurgery, Geisinger Health System, Danville, PA, USA
3
Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
4
Department of Neurosurgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
5
Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
6
Department of Neurosurgery, Babol University of Medical Sciences, Babol, Mazandaran, Iran
Though uncommon, iatrogenic internal carotid artery (ICA) injuries are associated with high rates of morbidity and mortality [1]. Associated complications include hemorrhage, thromboembolic events, carotid cavernous fistulas (CCF), and traumatic pseudoaneurysms [2]. In general, iatrogenic vascular injuries are categorized according to the causal diagnostic or therapeutic procedure, such as angiographic catheterization,
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