Receiving stents for brain blood vessel injury after blunt head trauma; is it necessary?

This study looked at whether medication is safer and more effective than inserting stents into blood vessels in the brain for treating blunt brain blood vessel injuries. 

Blunt head trauma is caused by a blow or injury to the head such as falling and hitting your head or a vehicle-related collision. It can cause blood vessles in the head to rupture leading to internal bleeding. The body’s natural way to stop bleeding is to thicken and clot the blood once it leaks outside the blood vessel resulting in a pseudoaneurysm (false swelling of the wall of an artery). However, blood clots can be dangerous and can cause a stroke which is a disruption of oxygen supply to brain regions.

Stenting (balloon angioplasty) is a surgery that inserts stents (small flexible mesh tubes) into blood vessels to widen them and increase blood flow. The stent is normally inserted into the groin area and moved along the blood system until it reaches the narrowed artery where a small balloon within the tube is then inflated in the artery and the blood vessle is dilated and blood flow restored. The blood clot is then broken down using blood thinners such as antithrombotic (thrombus = blood clot) medication. An alternative therapy to stenting is to use antithrombotic therapy alone, rather than stenting. Antithrombotic therapy may be safer than stenting as stenting surgery carries possible risks rupturing blood vessels causing internal bleeding and stroke. However, it is not known if antithrombotic therapy is more effective than stenting surgery. 

This study investigated whether antithrombotic medication alone is more effective than stenting surgery among patients with severe vascular injury and blood clots that have leaked outside the ruptured blood vessel (pseudoaneurysm). A total of 195 patients were included in the study and from 1996-2005 patients received stents until risks of stents for head injury were reported and patients then received antithrombotic therapy alone.

The study found that before 2005, 25% (21 of 86) of patients underwent stent placement, with 2 of these patients having subsequently suffered from a stroke. Among patients treated with antithrombotics alone before 2005 (69 patients), 1 had a stroke. After 2005, only 2% (2 of 109) of patients had stents placed and no patient treated with antithrombotics or stent suffered a stroke and there was no rupture of a pseudoaneurysm.

Antithrombotic treatment for brain blood vessel injury after blunt head trauma is effective for stroke prevention. Stenting for brain blood vessels involves increased costs and potential risk of stroke, and does not appear to provide additional benefit. The study suggests that only patients with severe trauma or enlarging pseudoaneurysms should receive stents. 

The study only included 2 patients that received stents after 2005. Neither of these patients had a stroke yet it remains too small of a number to provide accurate information. Also second and third generation stents (newer stents) have since been released which may prove more safe and effective. Furthermore, doctors may have become more familiar with surgical techniques over time so these could reduce the risks of stenting.

If you or someone you know have suffered from blunt head trauma and have internal bleeding, talk to a doctor about the benefits and risks of antithrombotic therapy and stenting surgery.