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Updated: Feb 15, 2026
Simulator Training for Endovascular Neurosurgery
Published on: May 6, 2020
The changing role of endovascular stenting for blunt cerebrovascular injuries
Charles P Shahan1, John P Sharpe, Shaun M Stickley
1From the Department of Surgery (C.P.S., J.P.S., S.M.S., N.R.M., D.M.F., T.C.F., M.A.C., L.J.M.), University of Tennessee Health Science Center, Memphis, Tennessee.
Insights
Early anticoagulation is the primary treatment for blunt cerebrovascular injuries (BCVI). While endovascular stenting for BCVI is less common now, it remains crucial for specific injuries like pseudoaneurysms and dissections.
Area of Science:
- Vascular Surgery
- Neurosurgery
- Trauma Surgery
Background:
- Blunt cerebrovascular injuries (BCVI) management, particularly the role of endovascular stenting, remains a subject of debate.
- Early anticoagulation is the established primary therapy for BCVI.
Purpose of the Study:
- To evaluate the utilization and outcomes of endovascular stenting in BCVI patients.
- To identify specific BCVI types currently treated with stents.
Main Methods:
- Retrospective analysis of BCVI patients from 2011-2016, divided into two groups (2011-2012 and 2013-2016) based on treatment paradigm shift.
- Digital subtraction angiography for injury confirmation and heparin for initial therapy in all patients.
- Stratification by age, sex, injury severity, and treatment modality (stenting vs. anticoagulation alone).
Main Results:
- A significant decrease in endovascular stenting for BCVI was observed in the later period (8.9% vs. 34%).
- Stenting in the later period was primarily used for grade III pseudoaneurysms and grade II dissections.
- No significant difference in BCVI-related stroke rates was found between the two study periods despite reduced stenting.
Conclusions:
- Anticoagulation alone is sufficient for most BCVI cases.
- Endovascular stenting should be reserved for specific indications, including enlarging pseudoaneurysms and dissections with significant narrowing.
- Prospective studies are needed to determine which BCVI injuries benefit most from stent placement.
Background:
Few injuries have produced as much debate with respect to management as have blunt cerebrovascular injuries (BCVIs). Without question, early anticoagulation is the mainstay of therapy for these injuries. However, the role of endovascular stenting for BCVI remains controversial. Our purpose was to examine the use of endovascular stents for BCVI and outcomes and describe which injuries are being treated with stents.
Methods:
Patients with BCVI from 2011 to 2016 were identified and stratified by age, sex, and injury severity. Patients were then divided into two groups (previous study [PS] = 2011-2012 and current study [CS] = 2013-2016) based on a paradigm shift in BCVI diagnosis and treatment at our institution. Beginning in 2013, a multidisciplinary team assumed care of patients with BCVI from interventional radiology. Digital subtraction angiography was used to confirmatory injuries in both groups and heparin used for initial therapy.
Results:
In the CS, 237 patients were diagnosed with BCVI compared with 128 patients in the PS. Both groups were clinically similar with no difference in distribution of vessels injured. Beginning in 2013, there was a significant decrease in the use of stents for these injuries. In fact, in the CS, only 21 (8.9%) patients were treated with endovascular stenting compared to 44 (34%) patients in the PS. Of patients in the CS, 14 had grade III pseudoaneurysms and seven had grade II dissections. Despite this reduction in stenting, there was no significant change in the BCVI-related stroke rate between the CS and the PS (4.2% vs. 3.9%).
Conclusion:
Anticoagulation alone is adequate therapy for the majority of BCVI. Nevertheless, there is still a role for endovascular stents in the treatment of BCVI. Their use should be reserved for enlarging carotid pseudoaneurysms and dissections with significant narrowing. The prospect of determining which injuries benefit from stent placement warrants prospective investigation.
Level Of Evidence:
Therapuetic/care management, level IV.
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