{"title":"The Acute Management of Penetrating Carotid Artery Injuries: A Systematic Review","authors":"Saskya Byerly , Jacqueline Stuber , Devanshi Patel , Jenessa McElfresh , Gregory A. Magee","doi":"10.1016/j.avsg.2025.01.018","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Penetrating carotid artery injuries (CAIs) are rare with high morbidity and mortality. We aimed to perform a systematic review of the published literature to evaluate the work-up and management of penetrating CAI.</div></div><div><h3>Methods</h3><div>Studies of acute management of adult trauma patients with penetrating common or internal CAIs on MEDLINE or EMBASE from 1946 through July 2024 were included following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement methodology. Exclusion criteria was case series with <5 patients, review articles, animal studies, cadaver studies, non-English language, and age<18. Risk of bias was assessed with Oxford Level of Evidence and findings evaluated via Grading of Recommendations, Assessment, Development, and Evaluations.</div></div><div><h3>Results</h3><div>Our systematic review identified 4,737 studies, of which 35 were included. Preoperative evaluation transitioned to screening computed tomography angiography of the neck in the absence of hard signs. Management now includes endovascular and nonoperative in select cases: nonoperative for some small intraluminal injuries and stenting or embolization for surgically inaccessible lesions. Repair or revascularization was preferred in all but neurologically devastated comatose patients, in which, ligation was deemed acceptable. Temporary intravascular shunting with a takeback for definitive revascularization was associated with a 100% stroke or death. Postoperative antiplatelet or anticoagulation therapy and follow-up was nonstandardized with a shift toward antiplatelet therapy for all injuries described more recently.</div></div><div><h3>Conclusions</h3><div>Penetrating CAI remains challenging with a shift toward less invasive initial workup with computed tomography angiography and management including endovascular and nonoperative in select cases. Temporary intravascular shunting with delayed revascularization and ligation were both associated with poor outcomes. Postoperative antiplatelet therapy has become increasingly common and postoperative surveillance is not standardized.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"113 ","pages":"Pages 120-137"},"PeriodicalIF":1.6000,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0890509625000457","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
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Abstract
Background
Penetrating carotid artery injuries (CAIs) are rare with high morbidity and mortality. We aimed to perform a systematic review of the published literature to evaluate the work-up and management of penetrating CAI.
Methods
Studies of acute management of adult trauma patients with penetrating common or internal CAIs on MEDLINE or EMBASE from 1946 through July 2024 were included following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement methodology. Exclusion criteria was case series with <5 patients, review articles, animal studies, cadaver studies, non-English language, and age<18. Risk of bias was assessed with Oxford Level of Evidence and findings evaluated via Grading of Recommendations, Assessment, Development, and Evaluations.
Results
Our systematic review identified 4,737 studies, of which 35 were included. Preoperative evaluation transitioned to screening computed tomography angiography of the neck in the absence of hard signs. Management now includes endovascular and nonoperative in select cases: nonoperative for some small intraluminal injuries and stenting or embolization for surgically inaccessible lesions. Repair or revascularization was preferred in all but neurologically devastated comatose patients, in which, ligation was deemed acceptable. Temporary intravascular shunting with a takeback for definitive revascularization was associated with a 100% stroke or death. Postoperative antiplatelet or anticoagulation therapy and follow-up was nonstandardized with a shift toward antiplatelet therapy for all injuries described more recently.
Conclusions
Penetrating CAI remains challenging with a shift toward less invasive initial workup with computed tomography angiography and management including endovascular and nonoperative in select cases. Temporary intravascular shunting with delayed revascularization and ligation were both associated with poor outcomes. Postoperative antiplatelet therapy has become increasingly common and postoperative surveillance is not standardized.
期刊介绍：
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence
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