Cerebrovascular Trauma
Conditions
Keywords
penetrating cerebrovascular injury, nonoperative management, penetrating neck trauma, natural history, antithrombotic therapy, case series
Brief summary
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.
Detailed description
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.
Interventions
OTHERNo intervention
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.
Sponsors
Denver Health Medical Center
Poudre Valley Health System
Study design
Observational model
CASE_ONLY
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Penetrating neck trauma * Carotid or vertebral artery injury
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| number of patients with stroke | up to one year post-injury | ischemic stroke |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| number of patients with injury progression | up to one year post-injury | CTA progression of PCVI severity (Grade) |
| number of patients with death | up to one year post-injury | death |
| number of patients with bleeding complications | up to one year post-injury | intracranial hemorrhage, GI bleed, etc requiring change in treatment |
| number of patients treated with operative exploration | up to one year post-injury | 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. |
| number of patients treated with arterial embolization or arterial stent placement | up to one year post-injury | IR procedures are adjuncts to nonoperative management. Performance of these procedures is readily attainable from IR procedure reports. |
Outcome results
None listed