Abstract Background and aims Penetrating blast injuries of neck arteries pose significant risk of stroke. Different types of dissections have different risks of secondary stroke and the need for endovascular treatment. The least aggressive is Denver1. Objective: to assess the role of delayed DSA in Denver 1 dissections of the neck arteries in detecting conversion to more aggressive types and the role of endovascular treatment for prevention of secondary stroke. Methods Among 2259 patients with penetrating blast trauma to the neck from February 24, 2022 to February 09, 2026, 258 had a dissection injury of neck arteries. 39 patients had a non-aggresive Denver 1. All of these patients underwent a control delayed DSA on day 10-14 to exclude conversion to more aggressive types. In cases of such a transition, endovascular treatment was performed in a single session. Results In 39 patients with neck arteries Denver1 dissections, DSA revealed the transition to Denver 3 in 11 cases (28%). This type is dangerous leads to stroke in 40%. Endovascular treatment was performed. In 7 cases -graft stent implantations, 2 - coiling with stent assistance, 2-implantation of a flow diverter with coiling. Secondary ischemic events were not observed during 90 days. Conclusions Even the previously considered non-aggressive type of Denver 1 artery dissection poses a significant risk to the patient due to its conversion to type 3 due to the risk of distal embolism. Control digital DSA should become a mandatory component of monitoring such patients. Endovascular treatment is an effective strategy for stroke prevention in patients with Denver3 Conflict of interest
Cherednychenko et al. (2026) studied this question.