Trauma to the head and neck can have serious consequences to the patient. Damage to an artery can result in severe bleeding or in an expanding clot around the hole in the vessel (pseudoaneurysm). This clot can produce pressure on other structures, affecting breathing and swallowing. If there is damage to both the artery and vein, an abnormal connection between the two may develop (arteriovenous fistula) which results in the abnormal blood flow from the artery through the hole into the vein and back to the heart instead of from the artery into the brain.
Damage to an artery can also result in partial blockage of the vessel due to a process called “dissection.” A dissection is where the layers of an artery come apart often with bleeding occurring between the layers. This kind of damage can reduce blood flow to the brain as well as result in blood clots, which can break off and travel to the brain, causing strokes.
Some traumatic vascular lesions such as holes in the carotid artery with bleeding are best treated surgically. But in particular cases, surgery is not possible or is not safe. If there is bleeding from branches of a major artery such as the carotid artery, endovascular treatment can be performed by inserting a catheter into the damaged blood vessel(s) and injecting materials to block off the opening. If there is a hole in the main artery with a clot around it, this condition may be treated by inserting a stent (a metal device designed to hold a vessel open) through the catheter and placing it across the hole. Once the stent is secure, material can be injected into the hole and clot to close the hole completely. If a fistula is present, a catheter may be placed into the connection between the artery and vein and material may be injected to close the connection.
Sometimes, the only way to treat an injury to an artery is to block off the artery itself. If this is necessary, a catheter fitted with a small balloon can be placed into the vessel. The balloon is inflated, stopping the flow of blood. The patient is checked every few minutes to see if the blockage causes symptoms (similar to those of a stroke). This is called test occlusion. If there are no symptoms, material can be injected through the catheter to block the vessel.