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A Rat Carotid Artery Pressure-Controlled Segmental Balloon Injury with Periadventitial Therapeutic Application
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Exploring the role of endovascular interventions in blunt carotid and vertebral artery trauma

Walter L Biffl1, Matthew Castelo1, Imad S Dandan1

  • 1Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA.

American Journal of Surgery
|August 21, 2023
PubMed

Insights

Endovascular interventions (EI) and antithrombotic therapy (AT) for blunt carotid and vertebral artery injuries (BCI/BVI) show limited stroke prevention. Thrombectomy may improve outcomes after stroke, necessitating further research.

Area of Science:

  • Vascular Surgery
  • Neurology
  • Trauma Care

Background:

  • The efficacy of endovascular interventions (EI) for blunt carotid and vertebral artery injuries (BCI and BVI) remains unclear.
  • Current treatment strategies require further definition to optimize patient outcomes.

Purpose of the Study:

  • To compare the effectiveness of EI versus antithrombotic therapy (AT) for BCI and BVI.
  • To provide data for future prospective studies on managing these injuries.

Main Methods:

  • Retrospective analysis of patient records from 2017-2022 at a Level I trauma center.
  • Inclusion of data on injury type, treatment received, and patient outcomes, with stroke as the primary outcome measure.

Main Results:

  • 106 injuries (74 BVI, 32 BCI) in 96 patients were analyzed; 13 EI were performed (4 therapeutic, 9 prophylactic).
  • Stroke occurred in 12 patients, with 6 having undergone EI. Stroke rates were low for grade IV BVI with both EI and AT.
  • Thrombectomy following stroke demonstrated a 100% improvement in neurologic function in 4 patients.

Conclusions:

  • The majority of strokes occurred before initiation of preventive therapy.
  • Neither AT nor EI guarantees complete stroke prevention; thrombectomy shows potential for improving post-stroke neurologic outcomes.
  • A prospective, multicenter study is essential to definitively establish optimal management strategies.
Abstract

Keywords:
Blunt carotid artery injuryBlunt cerebrovascular injuryBlunt vertebral artery injuryEndovascularStrokeThrombectomy

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