Abstract | BACKGROUND: Significant confusion exists about management of blunt carotid injuries ( BCI). Currently, three common treatments are being used without significant longterm followup data to demonstrate efficacy. Although heparin has been shown to reduce in-hospital stroke rates, antiplatelet therapy ( aspirin and clopidogrel) has emerged as an alternate therapy without proved efficacy; carotid stenting has also been implemented for pseudoaneurysms (13% BCI), but its utility has recently been challenged. This is the first study to assess longterm efficacy of various therapeutic approaches. STUDY DESIGN: Consecutive patients treated and followed at a single regional trauma center over 10 years (1996 to 2005) were reviewed. Outcomes evaluated included cerebral infarction, functional status, and angiographic evolution. RESULTS: One hundred ten patients (11/year) were diagnosed with 133 injuries (23 bilateral). Overall mortality was 26%, with 6% directly attributable to BCI. Angiographic followup was available on 67 injuries (in 50 patients) at a mean of 6 months (range 0.25 to 67 months); 75% remained the same or improved. Clinical followup was available in 55 of 81 patients (68%) who survived to discharge (mean, 34.4 months [range 1 to 109 months]). Of surviving patients receiving antithrombotic therapy, 44% were treated with antiplatelet therapy, 49% with anticoagulation, and 7% with both. No patients experienced cerebral infarction after discharge, and there was no difference in functional outcomes based on the therapy received. Twenty-two endovascular stents were placed (18 for pseudoaneurysms, 4 for extensive dissection). Mean followup on these patients was 29.7 months (range 3 to 94 months). No patients receiving stents experienced periprocedural complications, and one patient with an associated brain injury had a cerebral infarction. CONCLUSIONS:
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Authors | Norma M Edwards, Timothy C Fabian, Jeffrey A Claridge, Shelly D Timmons, Peter E Fischer, Martin A Croce |
Journal | Journal of the American College of Surgeons
(J Am Coll Surg)
Vol. 204
Issue 5
Pg. 1007-13; discussion 1014-5
(May 2007)
ISSN: 1072-7515 [Print] United States |
PMID | 17481530
(Publication Type: Journal Article)
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Topics |
- Adolescent
- Adult
- Aged
- Angiography
- Carotid Artery Injuries
(drug therapy, surgery)
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Longitudinal Studies
- Male
- Middle Aged
- Stents
- Thrombolytic Therapy
(methods)
- Treatment Outcome
- Wounds, Nonpenetrating
(drug therapy, surgery)
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