Risk Factors for Stroke in Penetrating Cerebrovascular Injuries.

Penetrating cerebrovascular injuries (PCVI) are associated with a high incidence of mortality and neurologic events. The optimal treatment strategy of PCVI, especially when damage control measures are required, remains controversial. The aim of this study is to describe the management of PCVI and patient outcomes at a level 1 trauma center where vascular injuries are predominantly managed by trauma surgeons. An institutional trauma registry was queried for patients with PCVI from 2011-2021. Patients with common carotid artery (CCA), internal carotid artery (ICA), or vertebral artery (VA) injuries were included for analysis. The primary outcome was in-hospital stroke. The secondary outcomes were in-hospital mortality and in-hospital stroke or death. A subgroup analysis was completed of arterial repair (primary repair or interposition graft) vs ligation/embolization vs temporary intravascular shunting at the index procedure. 54 patients with PCVI were analyzed. Overall, the in-hospital stroke rate was 17% and in-hospital mortality was 26%. Twenty-one patients (39%) underwent arterial interventions for PCVI. Ten patients underwent arterial repair, 6 patients underwent ligation/embolization, and 5 patients underwent intravascular shunting as damage control strategy with a plan for delayed repair. The rate of in-hospital stroke was 30% after arterial repair, 0% after arterial ligation or embolization, and 80% after temporary intravascular shunting. There was a significant difference in the stroke rate between the three subgroups (P=.015). Of the 32 patients that that did not have an intervention to the CCA, ICA, or VA, 1 patient with ICA occlusion and 1 patient with CCA intimal injury developed in-hospital stroke. The mortality rate was 0% after arterial repair, 50% after ligation or embolization, and 60% after intravascular shunting. The rate of stroke or death was 30% in the arterial repair group, 50% in the ligation or embolization group, and 100% in the temporary intravascular shunting group. High rates of stroke and mortality were seen in patients requiring damage control after PCVI. In particular, temporary intravascular shunting was associated with a high incidence of in-hospital stroke and 100% rate of stroke or death. Further investigation is needed into the factors related to these finding and whether the use of temporary intravascular shunting in PCVI is an advisable strategy.

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