Severe Pediatric Head Injury During the Iraq and Afghanistan Conflicts

Klimo, Paul; Ragel, Brian T.; Jones, G. Morgan; McCafferty, Randall

doi:10.1227/neu.0000000000000743

Cited by 32 publications

(30 citation statements)

References 36 publications

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“…Reports have suggested a higher stroke rate with surgical or endovascular ligation/occlusion compared to endovascular graft repair 4,7,12 , but stroke rates were not different between treatment modalities in our cohort. Endovascular occlusion of the internal and common carotid arteries is not commonly performed in our institution, with stent-grafts being the preferred endovascular solution in these vascular beds.…”

Section: Discussioncontrasting

confidence: 71%

“…The overall rate of reported late complications in CBS is low 4,5,14 , likely due in part to the extremely high one-year mortality rates seen in these patients. However, the implantation of prosthetic material into an irradiated field with potential skin exposure and chronic infection may predispose to infection.…”

Section: Discussionmentioning

confidence: 98%

“…The majority of surgical ligation procedures occurred in patients presenting with acute hemorrhage, necessitating emergency operation and preventing usage of adjuncts such as a balloon occlusion testing. Variable stroke rates have been seen in different cohorts ranging from 0-15% 4,7,12 .…”

Section: Discussionmentioning

confidence: 99%

“…Covered stent usage has been frequently utilized in those patients who have elective failed balloon test occlusion or are at risk for major neurological complications secondary to compromised cerebral perfusion and have been successfully used for the treatment of acute hemorrhage as well 4,5 . Despite the immediate hemostasis that covered stents provide, patients remain at risk for immediate complications such as stroke as well as long-term morbidities including recurrent bleeding, thrombosis, and infection 6,7 .…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of interventions for carotid blowout syndrome in patients with head and neck cancer

Liang

Guedes

Duvvuri

et al. 2016

Journal of Vascular Surgery

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Background The purpose of this study was to examine outcomes of a patient cohort undergoing intervention for carotid blowout syndrome (CBS) associated with head and neck cancer. Methods Patients with head and neck cancer who presented with carotid-distribution bleeding from 2000-2014 were identified in the medical record. Primary outcomes were short and mid-term mortality and recurrent bleeding. Standard statistical methods and survival analysis were used to analyze study population characteristics and outcomes. Results Thirty-seven patients were included in the study. The mean age was 60.1±11.4 (74% male). All malignancies were squamous cell type, stage IV, in a variety of primary locations: 32% oral cavity, 24% larynx, 16% superficial neck, with the remainder in the oro, naso, and hypopharynx. 51% of bleeds were of common carotid, 29% external carotid, and 19% internal carotid origin. 68% presented with acute hemorrhage, 24% with impending bleed, and 8% with threatened bleed. All patients underwent intervention: 38% received endovascular coil embolization, 30% stent grafts, 22% surgical ligation, and 10% primary vessel repair or bypass grafting. 10.8% of patients had perioperative stroke; other major complications were rare. Sixteen recurrent bleeding episodes involving 12 arteries occurred in 11 patients (29.73%). Median rebleeding time was seven days (IQR 6-49). Estimated recurrent bleeding risk at 30-days and 6 months was 24% and 34% respectively. 91.9% of patients survived to hospital discharge. 90-day and 1-year estimated survival was 60.9% and 36.6% respectively. Conclusions CBS associated with head and neck cancer carries poor mid- and long-term prognoses; however, mortality may be related more to the advanced stage of disease rather than carotid involvement or associated intervention. Both surgical and endovascular approaches may be efficacious in cases of acute hemorrhage but carry a significant risk of periprocedural stroke and recurrent bleeding.

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Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of interventions for carotid blowout syndrome in patients with head and neck cancer

Liang

Guedes

Duvvuri

et al. 2016

Journal of Vascular Surgery

View full text Add to dashboard Cite

show abstract

“…Tüm bunların yapılması sırasında iki ana prensip göz önünde bulundurulmalıdır (28) : 1) Anormal fizyolojik olaylardan kaynaklanan ilave beyin zedelenmesini önceden görmek ve önlemek 2) Bir kısmı zedelenmiş, ancak potansiyel fonksiyonu olan nöral yapıların iyileşmesi için ideal fizyolojik ortamı hazırlamaktır.…”

Section: Tanıunclassified