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Management And Outcomes Of Traumatic Carotid Injuries
Priscilla Tanamal, MD, Sophia Trinh, MD, Amit Chawla, MD, Amanda Tullos, MD, Danielle Sethi, MD, Madeline Dills, MD, Claudie Sheahan, MD, Malachi Sheahan, III, MD.
Louisiana State University Health Sciences Center, New Orleans, LA, USA.
INTRODUCTION: Carotid artery injuries carry a high risk of morbidity and mortality. Due to their variable presentation management paradigms are not standardized. Our goal was to examine the outcomes of blunt and penetrating carotid artery injuries.
METHODS: All patients over 18 years old with traumatic common (CCA) or internal carotid (ICA) injury between 2010 and 2021 were retrospectively identified from our prospectively maintained database.
RESULTS: Eighty-six patients were identified. Average age was 35.7 years (range 18 to 91). Majority were male (n=67; 77.9%) and Black (n=56, 65.1%). Forty patients suffered from blunt trauma while 46 were penetrating. Twenty-six of the 40 patients with blunt injuries had neurological deficits on presentation. Of those with blunt injuries who presented neurologically intact, there was no worsening of neurologic function agnostic of intervention (n=14). Two patients with blunt injuries and deficits and were managed operatively with one suffering a new deficit. Of the 24 blunt injuries managed conservatively, 12 improved neurologically, seven had new strokes, and five succumbed to other injuries. Sixteen of the 46 patients with penetrating injuries presented neurologically intact. Ten underwent operative repair with one having a new neurological deficit while six were managed conservatively with one new neurological deficit. Thirty of the 46 patients with penetrating injury presented with neurologic deficits. Of the 23 managed operatively; eight had strokes, six improved neurologically, and eight died (three from other injuries). Only seven penetrating injuries were treated medically: one had a stroke, four improved, and two died from other injuries. Overall, of the 37 patients managed operatively (27 open and 10 endovascular), 20 had a new stroke. Factors not significantly associated with stroke included age, ISS score, time to repair, gender, artery involved, and operative versus medical management. Neurologic deficit on arrival and presence of avulsion/transection were found to be significantly associated with stroke (p=0.044 and 0.016 respectively).
CONCLUSIONS: Carotid injury patients who present with neurologic deficits are significantly at risk of having a stroke during their hospitalization. Mechanism of injury and management were not found to be significantly associated with neurologic events. Of those who present neurologically intact, deterioration is rare.
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