Characterization of outcomes and practices utilized in the management of internal carotid artery injury not requiring definitive endovascular management.

Publication Title

Laryngoscope Investig Otolaryngol

Authors

Nyall R London
Abdulaziz AlQahtani
Siani Barbosa
Paolo Castelnuovo
Davide Locatelli
Aldo Stamm
Aaron A Cohen-Gadol
Hussam Elbosraty
Roy Casiano
Jacques Morcos
Ernesto Pasquini
Georgio Frank
Diego Mazzatenta
Garni Barkhoudarian, Pacific Brain Tumor Center and Pituitary Disorders Program John Wayne Cancer Institute at Providence Saint John's Health Center Santa Monica California USAFollow
Chester Griffiths, Pacific Brain Tumor Center and Pituitary Disorders Program John Wayne Cancer Institute at Providence Saint John's Health Center Santa Monica California USAFollow
Daniel Kelly, Pacific Brain Tumor Center and Pituitary Disorders Program John Wayne Cancer Institute at Providence Saint John's Health Center Santa Monica California USA
Christos Georgalas
Trichy N Janakiram
Piero Nicolai
Daniel M Prevedello
Ricardo L Carrau

Document Type

Article

Publication Date

8-1-2021

Keywords

california; jwci; sjci; psjhc; santa monica

Abstract

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.

Area of Special Interest

Cancer

Specialty/Research Institute

Otolaryngology

Specialty/Research Institute

Surgery

Specialty/Research Institute

Oncology