Outcomes of Grade 3 Carotid Dissections: A 7-Year Retrospective Analysis of Stroke, Stenosis, and Pseudoaneurysm Progression

Background: Grade 3 blunt cerebrovascular injuries (BCVIs), also known as pseudoaneurysms, are characterized by arterial wall injury forming a sac-like structure, which can sometimes be associated with stenosis and poses a substantial risk of ischemic stroke. This study evaluates the outcomes of traumatic Grade 3 internal carotid artery injuries treated at a single institution. Methods: A retrospective cohort study was conducted on 33 patients with Grade 3 carotid dissections treated between 2015 and 2022. Primary outcomes included stenosis progression, pseudoaneurysm status, and stroke occurrence. Results: At final imaging, 90.9 % of stenoses had resolved or improved, while 9.1 % remained unchanged or worsened. For pseudoaneurysms, 61 % had resolved or improved, while 39 % remained stable or worsened. Two patients (6.1 %) experienced strokes despite antiplatelet therapy, with one occurring early and one delayed. The majority (84.8 %) received conservative medical management, with only 9.1 % undergoing endovascular treatment. Conclusion: Grade 3 carotid dissections have variable outcomes, with most improving or resolving. However, the persistent risk of stroke and pseudoaneurysm progression emphasizes the need for vigilant long-term monitoring and reconsideration of optimal management strategies, particularly regarding the role of antiplatelet therapy and endovascular intervention.