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Vascular Balloon Injury and Intraluminal Administration in Rat Carotid Artery
Published on: December 23, 2014
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.
Insights
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.
Objective:
To review a series of patients who sustained internal carotid artery (ICA) gunshot wounds.
Design, Materials, And Methods:
We retrospectively studied the demographics and clinical presentation, angiographic findings, methods of treatment, and outcome of 38 consecutive patients who had ICA injury identified by angiography.
Results:
Thirty-four of 38 patients were symptomatic with neck hematomas (32 patients), active hemorrhage (12 patients), and/or neurologic deficit (10 patients). Angiography showed active bleeding in 22 patients and occlusion in 16 patients. Twelve patients were treated operatively by ligation (seven patients), repair (four patients), or intracranial/extracranial bypass (one patient). Twenty-six patients were managed nonoperatively either by angioplasty (one patient), embolotherapy (17 patients), or observation alone (eight patients). Percutaneous balloon catheters were also used in three patients for vascular control of the ICA before operative repair or as a method of assessing intracranial collateral circulation. The mortality of 18.4% was largely related to strokes.
Conclusions:
Penetration of the ICA is a very severe injury with a high mortality. The major cause of death in this series was related to neurologic damage associated with carotid injury and shock. However, neurologic deficit among the survivors was uncommon and often resulted from emboli. Interventional radiology can play an important role in the management of these wounds and often obviates the need for operative exploration.
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