TY - JOUR
T1 - Characterization of outcomes and practices utilized in the management of internal carotid artery injury not requiring definitive endovascular management
AU - London, Nyall R.
AU - AlQahtani, Abdulaziz
AU - Barbosa, Siani
AU - Castelnuovo, Paolo
AU - Locatelli, Davide
AU - Stamm, Aldo
AU - Cohen-Gadol, Aaron A.
AU - Elbosraty, Hussam
AU - Casiano, Roy
AU - Morcos, Jacques
AU - Pasquini, Ernesto
AU - Frank, Georgio
AU - Mazzatenta, Diego
AU - Barkhoudarian, Garni
AU - Griffiths, Chester
AU - Kelly, Daniel
AU - Georgalas, Christos
AU - Janakiram, Trichy N.
AU - Nicolai, Piero
AU - Prevedello, Daniel M.
AU - Carrau, Ricardo L.
N1 - Publisher Copyright:
© 2021 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC. on behalf of The Triological Society.
PY - 2021/8
Y1 - 2021/8
N2 - Background: After internal carotid artery (ICA) injury during endoscopic skull base surgery, the majority of patients undergo ICA embolization or stenting to treat active extravasation or pseudoaneurysm development. However, management practices when embolization or stenting is not required have not been well described. The objective of this study was to determine how patients with ICA injury but no embolization, stenting, or ligation do long-term and ascertain the reconstruction methods utilized. Methods: Twenty-nine cases of ICA injury were identified in an international multi-institutional retrospective review. Of these, we identified six cases that were not treated with embolization, stenting, or ICA sacrifice. Information was available for five cases. Results: A muscle patch was used in the immediate repair of each case. A nasoseptal flap was used in one case. Prefabricated nasal tampons were used in all cases. Nasal packing was initially left in for a median of 7 days prior to removal. The initial muscle patch was reinforced with a second muscle graft in one case. One case demonstrated ICA bleeding at the time of packing removal and was repacked an additional week. Follow-up for each of these cases was at least 2 years. No cases of subsequent carotid rupture were found and none of these cases ultimately underwent endovascular stenting. Radiation or proton therapy has not been subsequently used in any of these patients. Conclusions: This study details the reconstruction, lessons learned, and long-term follow-up for five cases of ICA injury not treated with embolization, stenting, or ligation.
AB - Background: After internal carotid artery (ICA) injury during endoscopic skull base surgery, the majority of patients undergo ICA embolization or stenting to treat active extravasation or pseudoaneurysm development. However, management practices when embolization or stenting is not required have not been well described. The objective of this study was to determine how patients with ICA injury but no embolization, stenting, or ligation do long-term and ascertain the reconstruction methods utilized. Methods: Twenty-nine cases of ICA injury were identified in an international multi-institutional retrospective review. Of these, we identified six cases that were not treated with embolization, stenting, or ICA sacrifice. Information was available for five cases. Results: A muscle patch was used in the immediate repair of each case. A nasoseptal flap was used in one case. Prefabricated nasal tampons were used in all cases. Nasal packing was initially left in for a median of 7 days prior to removal. The initial muscle patch was reinforced with a second muscle graft in one case. One case demonstrated ICA bleeding at the time of packing removal and was repacked an additional week. Follow-up for each of these cases was at least 2 years. No cases of subsequent carotid rupture were found and none of these cases ultimately underwent endovascular stenting. Radiation or proton therapy has not been subsequently used in any of these patients. Conclusions: This study details the reconstruction, lessons learned, and long-term follow-up for five cases of ICA injury not treated with embolization, stenting, or ligation.
KW - carotid artery injury
KW - carotid artery ligation
KW - embolization
KW - endoscopic skull base surgery
UR - http://www.scopus.com/inward/record.url?scp=85110349603&partnerID=8YFLogxK
U2 - 10.1002/lio2.621
DO - 10.1002/lio2.621
M3 - Article
C2 - 34401483
AN - SCOPUS:85110349603
SN - 2378-8038
VL - 6
SP - 634
EP - 640
JO - Laryngoscope Investigative Otolaryngology
JF - Laryngoscope Investigative Otolaryngology
IS - 4
ER -