Neurologic outcome after penetrating extracranial arterial trauma

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dc.contributor.authorDu Toit D.F.
dc.contributor.authorVan Schalkwyk G.D.
dc.contributor.authorWadee S.A.
dc.contributor.authorWarren B.L.
dc.date.accessioned2011-05-15T16:17:17Z
dc.date.available2011-05-15T16:17:17Z
dc.date.issued2003
dc.description.abstractPurpose: We undertook this study to determine factors that adversely affect outcome in patients with penetrating injury to the extracranial cerebral vasculature. Patients and Methods: Medical records were reviewed for all patients who had undergone surgical intervention to treat penetrating injury to the extracranial cerebral arteries between January 1989 and December 1999. Forensic autopsy findings were also reviewed for all patients who died as a result of their injury. Results: One hundred fifty-one patients with injury to the brachiocephalic artery (n = 21), common carotid artery (n = 98), or internal carotid artery (n = 32) were identified. Overall mortality was 21.2%, and stroke rate in surviving patients was 15.1%. Twenty-five of 32 deaths (78.1%) were stroke-related. Brachiocephalic artery injury was associated with the highest mortality (38.1%), and survivor stroke rate was highest in patients with internal carotid injuries (22.7%). Hemodynamic instability at presentation led to both higher mortality (30.7%) and stroke rate (19.2%). Preoperative angiography did not influence mortality or stroke rate in hemodynamically stable patients. Procedural mortality associated with arterial ligation was 45% (9 of 20 patients), and no surviving patient experienced a change in pre-ligation neurologic state. Nine patients remained neurologically intact after ligation, and 2 patients with preoperative localized neurologic deficit were unchanged postoperatively. In 131 patients, mortality after arterial repair was 17.6%, and in 5 surviving patients (5.4%) an ischemic neurologic deficit developed. Twelve of 15 surviving patients (80%) with preoperative neurologic deficit who underwent arterial repair had improved neurologic status. Cerebral infarcts were confirmed at autopsy in 23 patients; 18 infarcts were ischemic (10, repair; 8, ligation), and 5 infarcts were hemorrhagic (all, repair). No factor was identified that was predictive of ischemic versus hemorrhagic infarction in patients undergoing repair. Conclusions: The presence of hypovolemic shock, internal carotid artery injury, complete vessel transection, and arterial ligation are associated with unfavorable outcome. Penetrating injury to the brachiocephalic, common carotid, or internal carotid artery should be repaired rather than ligated when technically possible. Subsequent ischemic or hemorrhagic cerebral infarction is unpredictable, but overall outcome is superior to that with ligation of the injured artery. Copyright © 2003 by The Society for Vascular Surgery and The American Association for Vascular Surgery.
dc.description.versionReview
dc.identifier.citationJournal of Vascular Surgery
dc.identifier.citation38
dc.identifier.citation2
dc.identifier.issn07415214
dc.identifier.other10.1016/S0741-5214(03)00143-5
dc.identifier.urihttp://hdl.handle.net/10019.1/14149
dc.subjectangiography
dc.subjectartery injury
dc.subjectartery ligation
dc.subjectartery reconstruction
dc.subjectbrachiocephalic trunk
dc.subjectbrain infarction
dc.subjectbrain ischemia
dc.subjectcommon carotid artery
dc.subjecthemodynamics
dc.subjecthuman
dc.subjecthypovolemic shock
dc.subjectinternal carotid artery
dc.subjectmortality
dc.subjectnervous system injury
dc.subjectneurological complication
dc.subjectpreoperative treatment
dc.subjectpriority journal
dc.subjectreview
dc.subjectstroke
dc.subjectadolescent
dc.subjectadult
dc.subjectarticle
dc.subjectcarotid artery injury
dc.subjectfemale
dc.subjectinjury
dc.subjectmale
dc.subjectmiddle aged
dc.subjectneurologic disease
dc.subjectpenetrating trauma
dc.subjectretrospective study
dc.subjectAdolescent
dc.subjectAdult
dc.subjectBrachiocephalic Trunk
dc.subjectCarotid Artery Injuries
dc.subjectCerebral Infarction
dc.subjectFemale
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectNervous System Diseases
dc.subjectRetrospective Studies
dc.subjectWounds, Penetrating
dc.titleNeurologic outcome after penetrating extracranial arterial trauma
dc.typeReview
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