Penetrating Internal and Common Carotid Artery Injuries Shunts versus no shunts during repair effect on neurological outcomes

Asensio, Juan A.; Kessler, John J.; Kotaru, Tharun R.; Kalamchi, Louay D.; Miljkovic, Stephanie S.; Dabestani, Parinaz J.

doi:10.1016/j.injury.2020.11.032

Cited by 6 publications

(14 citation statements)

References 37 publications

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“…Use of temporary intravascular shunts for cervical carotid injuries has been shown to improve neurological outcomes. 17 Another potential explanation for the differences in stroke rates between military and civilian patients may relate to ischemic time, that is, the time from injury to restoration of flow. Although ischemic time was not able to be determined from the DoDTR or the PROOVIT database, it is possible that longer evacuations to surgical care were present in the military cohort given the nature of combat.…”

Section: Discussionmentioning

confidence: 99%

A multi-registry analysis of military and civilian penetrating cervical carotid artery injury

Ronaldi¹,

Polcz²,

Robertson³

et al. 2021

J Trauma Acute Care Surg

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Penetrating cervical carotid artery injury is an uncommon but high-stake scenario associated with stroke and death. The objective of this study was to characterize and compare penetrating carotid injury in the military and civilian setting, as well as provide considerations for management. METHODS:Cohorts with penetrating cervical carotid artery injury from the Department of Defense Trauma Registry (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) and the American Association for the Surgery of Trauma Prospective Observation Vascular Injury Treatment Registry (2012-2018) were analyzed. A least absolute shrinkage and selection operator multivariate analysis using random forest-based imputation was performed to identify risk factors affecting stroke and mortality. RESULTS:There were a total of 157 patients included in the study, of which 56 (35.7%) were military and 101 (64.3%) were civilian. The military cohort was more likely to have been managed with open surgery (87.5% vs. 44.6%, p < 0.001) and to have had any procedure to restore or maintain flow to the brain (71.4% vs. 35.6%, p < 0.001), while the civilian cohort was more likely to undergo nonoperative management (45.5% vs. 12.5%, p < 0.001). Stroke rate was higher within the military cohort (41.1% vs. 13.9%, p < 0.001); however, mortality did not differ between the groups (12.5% vs. 17.8%, p = 0.52). On multivariate analysis, predictors for stroke were presence of a battle injury (log odds, 2.1; p < 0.001) and internal or common carotid artery ligation (log odds 1.5, p = 0.009). For mortality outcome, protective factors included a high Glasgow Coma Scale on admission (log odds, −0.21 per point; p < 0.001). Increased admission Injury Severity Score was a predictor of mortality (log odds, 0.05 per point; p = 0.005). CONCLUSION:The stroke rate was higher in the military cohort, possibly reflecting complexity of injury; however, there was no difference in mortality between military and civilian patients. For significant injuries, concerted efforts should be made at carotid reconstruction to reduce the occurrence of stroke.

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Section: Discussionmentioning

confidence: 99%

A multi-registry analysis of military and civilian penetrating cervical carotid artery injury

Ronaldi¹,

Polcz²,

Robertson³

et al. 2021

J Trauma Acute Care Surg

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“…datory neck exploration [3][4][5]. Emergent neck exploration is indicated if there are overt symptoms or signs, including airway compromise, massive subcutaneous emphysema, active bleeding, shock, stroke, and expanding hematoma [3][4][5]. This patient experienced massive external bleeding with shock, which was an indication for emergent surgery.…”

Section: A a B Bmentioning

confidence: 99%

“…Previous reports described poorer outcomes for the ligation of ICA or CCA injuries than for the repair of ICA or CCA injuries [3,[8][9][10][11][12][13][14]. Patients who underwent ligation had higher rates of mortality (22% vs.10%) and stroke (88.9% vs. 33.3%) than those who underwent repair [3]. Therefore, if possible, repair of the injured carotid artery is recommended rather than ligation [3].…”

Section: A a B Bmentioning

confidence: 99%

“…The neck contains many important communicating structures between the head and torso, including blood vessels, the aerodigestive tract, vertebrae, and the spinal cord in a small area. In particular, penetrating neck injuries associated with carotid artery injuries are known to have a high mortality rate [1][2][3]. With the recent advent of selective nonoperative management for penetrating neck injuries, neck exploration is not always mandatory [3][4][5].…”

mentioning

confidence: 99%

“…In particular, penetrating neck injuries associated with carotid artery injuries are known to have a high mortality rate [1][2][3]. With the recent advent of selective nonoperative management for penetrating neck injuries, neck exploration is not always mandatory [3][4][5]. However, overt external hemorrhage is unanimously considered to be an indication for surgical exploration.…”

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confidence: 99%

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Successful management of a common carotid artery injury using a Pruitt-F3 Carotid Shunt: a case report

et al. 2022

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Penetrating neck injuries are a surgical challenge. In particular, penetrating neck injuries associated with carotid artery injuries have a high mortality rate. Overt external hemorrhage is unanimously considered as an indication for surgical exploration. The authors present a case of successful surgical management for a penetrating common carotid artery injury using a Pruitt-F3 Carotid Shunt (LeMaitre Vascular Inc., Burlington, MA, USA) in a 60-year-old male patient who was transferred to the level 1 trauma center due to a metal fragment piercing his neck while working. Active pulsatile bleeding was observed from the 3-cm-long external wound on the anterior neck in zone II. Emergent neck exploration showed near-total transection of the left common carotid artery just below the carotid bifurcation. After a Pruitt-F3 Carotid Shunt was applied to the injured carotid artery as a temporary vascular shunt, artificial graft interposition was performed for the injured common carotid artery. The patient experienced cerebral infarction as a complication caused by ischemia-reperfusion of the common carotid artery but was discharged in a suitable state for rehabilitation therapy.

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Epidemiology, repair technique, and predictors of stroke and mortality in penetrating carotid artery injuries

Plotkin

Owattanapanich

Byerly

et al. 2023

Journal of Vascular Surgery

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Penetrating Internal and Common Carotid Artery Injuries Shunts versus no shunts during repair effect on neurological outcomes

Cited by 6 publications

References 37 publications

A multi-registry analysis of military and civilian penetrating cervical carotid artery injury

A multi-registry analysis of military and civilian penetrating cervical carotid artery injury

Successful management of a common carotid artery injury using a Pruitt-F3 Carotid Shunt: a case report

Epidemiology, repair technique, and predictors of stroke and mortality in penetrating carotid artery injuries

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