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Internal carotid artery gunshot wounds
S J Sclafani1, T M Scalea, W Wetzel
1Department of Radiology, State University of New York Health Science Center at Brooklyn, USA.
The Journal of Trauma
|May 1, 1996
Summary
Gunshot wounds to the internal carotid artery (ICA) are severe, often causing death from stroke. However, interventional radiology offers effective nonoperative management, reducing the need for surgery and improving outcomes for these complex vascular injuries.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Interventional Radiology
Background:
- Internal carotid artery (ICA) gunshot wounds represent a severe traumatic injury.
- These injuries carry a significant risk of mortality and morbidity, primarily due to neurologic complications.
Purpose of the Study:
- To review a series of patients with internal carotid artery (ICA) gunshot wounds.
- To analyze the clinical presentation, treatment modalities, and outcomes.
- To evaluate the role of interventional radiology in managing these injuries.
Main Methods:
- Retrospective review of 38 consecutive patients with ICA injury identified by angiography.
- Analysis of demographics, clinical presentation, angiographic findings, treatment methods (operative and nonoperative), and patient outcomes.
- Inclusion of data on the use of percutaneous balloon catheters for vascular control.
Main Results:
- 34 of 38 patients were symptomatic, presenting with neck hematomas, active hemorrhage, or neurologic deficits.
- Angiography revealed active bleeding in 22 patients and occlusion in 16.
- Nonoperative management, including embolotherapy, was utilized in 26 patients, while 12 underwent operative treatment.
Conclusions:
- Penetration of the ICA is a life-threatening injury with high mortality, often linked to neurologic damage and shock.
- Neurologic deficits in survivors were uncommon and frequently embolic.
- Interventional radiology plays a crucial role, often enabling nonoperative management and avoiding surgical exploration.