Risk factors for stroke in penetrating cerebrovascular injuries
Alexander D DiBartolomeo1, Brian Williams2, Fred A Weaver1
1Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA.
Journal of Vascular Surgery
|June 7, 2024
Summary
Penetrating cerebrovascular injuries (PCVI) management is debated. Temporary intravascular shunting showed high stroke and death rates, suggesting it may not be advisable for PCVI damage control.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Vascular Surgery
- Cerebrovascular Diseases
Background:
- Penetrating cerebrovascular injuries (PCVI) carry significant risks of mortality and neurological deficits.
- Optimal management strategies for PCVI, particularly those requiring damage control, remain a subject of controversy.
- Trauma surgeons predominantly manage vascular injuries at this level 1 trauma center.
Purpose of the Study:
- To describe the management approaches for PCVI at a level 1 trauma center.
- To evaluate patient outcomes, including stroke and mortality, following PCVI management.
- To compare outcomes of different arterial intervention strategies: repair, ligation/embolization, and temporary intravascular shunting.
Main Methods:
- A 10-year institutional trauma registry review (2011-2021) identified patients with PCVI.
- Included injuries involved the common carotid artery (CCA), internal carotid artery (ICA), or vertebral artery.
- Primary outcome was in-hospital stroke; secondary outcomes included mortality and stroke or death, with subgroup analysis of intervention types.
Main Results:
- Fifty-four patients with PCVI were analyzed; overall in-hospital stroke rate was 17% and mortality was 26%.
- Arterial interventions were performed in 21 patients: 10 repairs, 6 ligations/embolizations, and 5 temporary shunts.
- Stroke rates varied significantly: 30% (repair), 0% (ligation/embolization), and 80% (shunting); shunting also had a 100% stroke or death rate.
Conclusions:
- Damage control strategies for PCVI, especially temporary intravascular shunting, are associated with high rates of stroke and mortality.
- Temporary intravascular shunting demonstrated a particularly high incidence of in-hospital stroke and a 100% rate of stroke or death.
- Further research is warranted to investigate factors contributing to these outcomes and the advisability of temporary shunting in PCVI.
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