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Endovascular reconstruction of iatrogenic internal carotid artery injury following endonasal surgery: a systematic review

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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.

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Authors and Affiliations

  1. Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran

    Mohammad Ghorbani

  2. Department of Neurosurgery, Geisinger Health System, Danville, PA, USA

    Christoph J. Griessenauer

  3. Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria

    Christoph J. Griessenauer

  4. Department of Neurosurgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran

    Hamidreza Shojaei

  5. Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria

    Christoph Wipplinger

  6. Department of Neurosurgery, Babol University of Medical Sciences, Babol, Mazandaran, Iran

    Ebrahim Hejazian

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Correspondence to Hamidreza Shojaei.

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Ghorbani, M., Griessenauer, C.J., Shojaei, H. et al. Endovascular reconstruction of iatrogenic internal carotid artery injury following endonasal surgery: a systematic review. Neurosurg Rev 44, 1797–1804 (2021). https://doi.org/10.1007/s10143-020-01379-z

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