The goal of this study is to evaluate a series of cases of penetrating cerebrovascular injury managed without upfront operation. Investigators focus on patient characteristics, injury details, treatment modalities, serial imaging studies, patient outcomes, and complications. Investigators will compare this patient population to patients managed with upfront operation for context.
Penetrating cerebrovascular injuries (PCVIs) are uncommon, with little data to guide management when emergent operative repair is not performed. Investigators hypothesized that PCVIs may be managed with antithrombotic therapy and directed use of endovascular interventions, but that PCVIs may require enhanced surveillance due to a risk of delayed complications. To perform this study, investigators will review patients with penetrating carotid and vertebral artery injuries managed at an urban Level I trauma center from 2016 to 2022. Patients will be included if they underwent initial nonoperative management (NOM). Patient characteristics, injury details, treatments, serial imaging, outcomes, and complications will be assessed in a retrospective manner using chart abstraction. Investigators will briefly compare these patients to those managed with upfront operations for context.
Study Type
OBSERVATIONAL
Enrollment
20
This study did is a retrospective case series and does not involve an intervention. Investigators will compare patients managed operatively vs nonoperatively, focused on nonoperative therapy.
number of patients with stroke
ischemic stroke
Time frame: up to one year post-injury
number of patients with injury progression
CTA progression of PCVI severity (Grade)
Time frame: up to one year post-injury
number of patients with death
death
Time frame: up to one year post-injury
number of patients with bleeding complications
intracranial hemorrhage, GI bleed, etc requiring change in treatment
Time frame: up to one year post-injury
number of patients treated with operative exploration
All patients in cohort are treated with initial trial of nonoperative management. This outcome assesses the number of patients who subsequently required operative neck exploration. This is readily attainable from operative reports.
Time frame: up to one year post-injury
number of patients treated with arterial embolization or arterial stent placement
IR procedures are adjuncts to nonoperative management. Performance of these procedures is readily attainable from IR procedure reports.
Time frame: up to one year post-injury
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