scholarly journals Successful Management of Internal Carotid Artery Transection Secondary to a Gunshot Wound and Subsequent Malignant MCA Syndrome

2021 ◽  
pp. 276-283
Author(s):  
George Cairns ◽  
Alex Belshaw
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Gunshot Wound ◽  
Internal Carotid ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Gunshot Wounds ◽  
High Rate ◽  
Major Surgery ◽  
Artery Ligation

There are over 100,000 strokes each year in the UK. A very small proportion of these can be attributed to gunshot wounds and subsequent surgical intervention. We present a rare case of a 24-year-old male patient admitted to the Emergency Department having sustained a gunshot wound to the left side of his neck. Initial imaging and surgical exploration revealed significant left-sided vertebral artery damage and a complete transection of the internal carotid artery. Following damage control surgery (DCS), the patient was admitted to ITU but had an acute neurological deterioration and was found to have suffered malignant middle cerebral artery (MCA) syndrome, requiring an urgent decompressive craniectomy. The patient’s National Institutes of Health Stroke Scale (NIHSS) at this stage was 26. After a prolonged ITU stay and repatriation to a local stroke unit for intensive therapies input, the patient walked out of the hospital independently on day 106, with an improved NIHSS of 3. This case report aims to highlight the rarity of an ischaemic stroke, secondary to the DCS required for a near fatal gunshot wound, along with the importance of timely recognition of an acute deterioration following artery ligation. Additionally, it aims to examine the lifesaving surgical management of malignant MCA syndrome and in turn the significance of the shared decision-making process between clinicians, the patient, and family members, due to the high rate of poor functional outcomes following this major surgery.

Embolic stroke after carotid artery ligation during carotid body tumor resection

Vascular ◽  
2011 ◽  
Vol 21 (1) ◽  
pp. 23-26
Author(s):  
Hyangkyoung Kim ◽  
Yong-Pil Cho ◽  
Ki-Myung Moon ◽  
Tae-Won Kwon
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Body ◽  
Internal Carotid ◽  
Tumor Resection ◽  
Antiplatelet Agents ◽  
Carotid Body Tumor ◽  
Tumor Surgery ◽  
Artery Ligation ◽  
Carotid Artery Ligation

This report describes a case of a delayed cerebral embolic infarction, after internal carotid artery (ICA) ligation secondary to carotid body tumor resection. We describe a 34-year-old woman who underwent left ICA ligation during a large carotid body tumor surgery. Immediately after surgery, the patient was neurologically asymptomatic; however, she subsequently developed a cerebral embolic infarction nine hours postoperatively. After beginning antiplatelet therapy, all symptoms ultimately resolved, although over a gradual course. Since the ligation of the ICA can cause thromboembolic infarctions of the cerebrum, we contend that antiplatelet agents be administered to prevent and/or treat embolic strokes.

scholarly journals Surgical management of superior petrosal sinus dural arteriovenous fistulae with dominant internal carotid artery supply

2018 ◽  
Vol 24 (3) ◽  
pp. 331-338 ◽  
Author(s):  
Christopher J Stapleton ◽  
Anoop P Patel ◽  
Brian P Walcott ◽  
Collin M Torok ◽  
Matthew J Koch ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Surgical Intervention ◽  
High Rate ◽  
External Carotid ◽  
Arteriovenous Fistulae ◽  
Surgical Closure ◽  
Superior Petrosal Sinus

Background While technological advances have improved the efficacy of endovascular techniques for tentorial dural arteriovenous fistulae (DAVF), superior petrosal sinus (SPS) DAVF with dominant internal carotid artery (ICA) supply frequently require surgical intervention to achieve a definitive cure. Methods To compare the angiographic and clinical outcomes of endovascular and surgical interventions in patients with SPS DAVF, the records of all patients with tentorial DAVF from August 2010 to November 2015 were reviewed. Results Within this cohort, eight patients with nine SPS DAVF were eligible for evaluation. Five DAVF were initially treated with endovascular embolization, while four underwent surgical occlusion without embolization. Of the SPS DAVF treated with embolization, two (40%) remained occluded on follow-up, while the remaining three (60%) persisted/recurred and required surgical intervention for definitive closure. Of the four SPS DAVF treated with primary surgical occlusion, all four (100%) remained closed on follow-up. In addition, of the three SPS DAVF that persisted/recurred following embolization and required subsequent surgical closure, all three (100%) remained occluded on follow-up. Two (100%) SPS DAVF that were successfully treated with embolization had major or minor external carotid artery supply, while the three (100%) persistent lesions had major ICA supply via the meningohypophyseal trunk (MHT). Three (75%) of the four SPS DAVF treated with primary surgical occlusion had dominant MHT supply. Conclusion Complete endovascular closure of SPS DAVF with dominant ICA supply via the MHT may be difficult to achieve, while upfront surgical intervention is associated with a high rate of complete occlusion.

scholarly journals Pseudoaneurysma of the internal carotid artery caused by a gunshot wound

2013 ◽  
Vol 8 (S1) ◽  
Author(s):  
Dragan Piljić ◽  
Mustafa Tabaković ◽  
Amir Tursunović
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Gunshot Wound ◽  
Internal Carotid

Endovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature

2016 ◽  
Vol 125 (5) ◽  
pp. 1256-1276 ◽  
Author(s):  
Peter T. Sylvester ◽  
Christopher J. Moran ◽  
Colin P. Derdeyn ◽  
DeWitte T. Cross ◽  
Ralph G. Dacey ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Coil Embolization ◽  
Internal Carotid ◽  
Flow Diverter ◽  
High Rate ◽  
Review Of The Literature ◽  
Endonasal Surgery ◽  
Technical Complications ◽  
Technical Complication

OBJECTIVE Internal carotid artery (ICA) injury is a rare but severe complication of endonasal surgery. The authors describe their endovascular experience managing ICA injuries after transsphenoidal surgery; they review and summarize the current literature regarding endovascular techniques; and they propose a treatment algorithm based on the available evidence. METHODS A retrospective review of 576 transsphenoidal pituitary adenoma resections was performed. Cases of ICA injury occurring at our institution and transfers from other hospitals were evaluated. Endovascular treatments for ICA injury reported in the literature were also reviewed and summarized. RESULTS Seven cases were identified from the institutional cohort (mean age 46.3 years, mean follow-up 43.4 months [1–107 months]) that received endovascular treatment for ICA injury. Five injuries occurred at our institution (5 [0.9%] of 576), and 2 injuries occurred at outside hospitals. Three patients underwent ICA sacrifice by coil placement, 2 underwent lesion embolization (coil or stent-assisted coil placement), and 2 underwent endoluminal reconstruction (both with flow diversion devices). Review of the literature identified 98 cases of ICA injury treated with endovascular methods. Of the 105 total cases, 46 patients underwent ICA sacrifice, 28 underwent lesion embolization, and 31 underwent endoluminal reconstruction. Sacrifice of the ICA proved a durable solution in all cases; however, the rate of persistent neurological complications was relatively high (10 [21.7%] of 46). Lesion embolization was primarily performed by coil embolization without stenting (16 cases) and stent-assisted coiling (9 cases). Both techniques had a relatively high rate of at least some technical complication (6 [37.5%] of 16 and 5 [55.6%] of 9, respectively) and major technical complications (i.e., injury, new neurological deficit, or ICA sacrifice) (5 [31.3%] of 16 and 2 [22.2%] of 9, respectively). Endoluminal reconstruction was performed by covered stent (24 cases) and flow diverter (5 cases) placement. Covered stents showed a reasonably high rate of technical complications (10 [41.7%] of 24); however, 8 of these problems were resolved, leaving a small percentage with major technical complications (2 [8.3%] of 24). Flow diverter placement was also well tolerated, with only 1 minor technical complication. CONCLUSIONS Endovascular treatments including vessel sacrifice, coil embolization (with or without stent assistance), and endoluminal reconstruction offer a tailored approach to ICA injury management after endonasal surgery. Vessel sacrifice remains the definitive treatment for acute, uncontrolled bleeding; however, vessel preservation techniques should be considered carefully in select patients. Multiple factors including vascular anatomy, injury characteristics, and risk of dual antiplatelet therapy should guide best treatment, but more study is needed (particularly with flow diverters) to refine this decision-making process. Ideally, all endovascular treatment options should be available at institutions performing endonasal surgery.

Internal Carotid Artery Gunshot Wounds

1996 ◽  
Vol 40 (5) ◽  
pp. 751-757 ◽  
Author(s):  
Salvatore J. A. Sclafani ◽  
Thomas M. Scalea ◽  
Warren Wetzel ◽  
Sharon Henry ◽  
Lisa Dresner ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Gunshot Wounds

Gunshot Wounds of the Internal Carotid Artery at the Skull Base

1997 ◽  
Vol 42 (1) ◽  
pp. 123-132 ◽  
Author(s):  
Robert C. Rostomily ◽  
David W. Newell ◽  
M. Sean Grady ◽  
Sharon Wallace ◽  
Stephen Nicholls ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Gunshot Wounds

scholarly journals Internal Carotid Artery Embolism by Shotgun Pellet

1978 ◽  
Vol 5 (3) ◽  
pp. 325-326 ◽  
Author(s):  
Jitendar M. Sethi ◽  
Bohdan Rozdilsky
Keyword(s):  
Foreign Body ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Gunshot Wound ◽  
Carotid Arteries ◽  
Short Communication ◽  
Internal Carotid ◽  
Cerebral Arteries ◽  
Artery Embolism ◽  
The Subject

SUMMARY:Various examples of foreign body embolization of cerebral arteries, usually followed by serious consequences, have been reported (Lindberg et al, 1961; Chason et al, 1963; Steele et al, 1972; Wetli et al, 1972). However, a shotgun pellet entering the left atrium of the heart through a gunshot wound of the chest with subsequent embolic occlusion of one of the carotid arteries appears to be unique. It is the subject of this short communication.

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