Abstract：
BACKGROUND: This multicenter study examines the contemporary management of penetrating carotid artery injury (PCAI) to identify trends in management, outcomes, and to determine prognostic factors for stroke and death.
METHODS: Data from three large urban trauma centers in South Africa were retrospectively reviewed for patients who presented with PCAI from 2012 to 2020.
RESULTS: Of 149 identified patients, 137 actively managed patients were included. Twenty-four patients (17.9%) presented in coma and 12 (9.0%) with localizing signs (LS). CT angiography was performed on admission for 120 (87.6%) patients. Thirty patients (21.9%) underwent nonoperative management, 87 (63.5%) open surgery, and 20 (14.6%) endovascular stenting. Eighteen patients (13.1%) died, and 15 (12.6%) surviving patients had strokes. Ligation was significantly related to death and reperfusion to survival. A mechanism of gunshot wound, occlusive injuries, a threatened airway, a systolic blood pressure <90 mmHg, hard signs of vascular injury, a low GCS, coma, a CT brain demonstrating infarct, a high injury severity score and shock index, a low pH or HCO3, and an elevated lactate were significant independent prognostic factors for death. Ligation was unsurvivable in all patients with severe neurological deficits, whereas reperfusion procedures resulted in survival in 63% (12/19) patients with coma and 78% (7/9) with LS although with high stroke rates (coma: 25.0%, LS: 85.7%).
CONCLUSIONS: Outcomes in PCAI, including patients with severe neurological deficit and stroke, are better when reperfused. Reperfusion holds the best promise of survival and ligation should be reserved for technically inaccessible bleeding injuries.
METHODS: Data from three large urban trauma centers in South Africa were retrospectively reviewed for patients who presented with PCAI from 2012 to 2020.
RESULTS: Of 149 identified patients, 137 actively managed patients were included. Twenty-four patients (17.9%) presented in coma and 12 (9.0%) with localizing signs (LS). CT angiography was performed on admission for 120 (87.6%) patients. Thirty patients (21.9%) underwent nonoperative management, 87 (63.5%) open surgery, and 20 (14.6%) endovascular stenting. Eighteen patients (13.1%) died, and 15 (12.6%) surviving patients had strokes. Ligation was significantly related to death and reperfusion to survival. A mechanism of gunshot wound, occlusive injuries, a threatened airway, a systolic blood pressure <90 mmHg, hard signs of vascular injury, a low GCS, coma, a CT brain demonstrating infarct, a high injury severity score and shock index, a low pH or HCO3, and an elevated lactate were significant independent prognostic factors for death. Ligation was unsurvivable in all patients with severe neurological deficits, whereas reperfusion procedures resulted in survival in 63% (12/19) patients with coma and 78% (7/9) with LS although with high stroke rates (coma: 25.0%, LS: 85.7%).
CONCLUSIONS: Outcomes in PCAI, including patients with severe neurological deficit and stroke, are better when reperfused. Reperfusion holds the best promise of survival and ligation should be reserved for technically inaccessible bleeding injuries.
摘要：
背景：这项多中心研究检查了穿透性颈动脉损伤（PCAI）的当代管理，以确定管理趋势，结果，并确定中风和死亡的预后因素。
方法：回顾性分析了南非三个大型城市创伤中心2012年至2020年接受PCAI治疗的患者的数据。
结果：在149名确定的患者中，包括137名积极管理的患者。24例（17.9％）出现昏迷，12例（9.0％）出现定位体征（LS）。120例（87.6％）患者入院时进行了CT血管造影。30例患者（21.9%）接受非手术治疗，87（63.5%）开腹手术，20（14.6%）血管内支架置入术。18名患者（13.1%）死亡，15例(12.6%)存活患者出现卒中.结扎与死亡和再灌注存活显著相关。枪伤机制，闭塞性损伤,受威胁的气道，收缩压<90mmHg,血管损伤的硬迹象，低GCS，昏迷,显示梗塞的CT脑,高损伤严重程度评分和休克指数,低pH或HCO3和乳酸升高是死亡的重要独立预后因素.所有严重神经功能缺损患者的结扎均无法存活，而再灌注手术导致63%(12/19)的昏迷患者和78%(7/9)的LS患者存活，尽管卒中发生率很高(昏迷:25.0%,LS：85.7%）。
结论：PCAI的结果，包括严重的神经功能缺损和中风患者，再灌注时更好。再灌注具有生存的最佳希望，结扎应保留用于技术上无法进入的出血损伤。
方法：回顾性分析了南非三个大型城市创伤中心2012年至2020年接受PCAI治疗的患者的数据。
结果：在149名确定的患者中，包括137名积极管理的患者。24例（17.9％）出现昏迷，12例（9.0％）出现定位体征（LS）。120例（87.6％）患者入院时进行了CT血管造影。30例患者（21.9%）接受非手术治疗，87（63.5%）开腹手术，20（14.6%）血管内支架置入术。18名患者（13.1%）死亡，15例(12.6%)存活患者出现卒中.结扎与死亡和再灌注存活显著相关。枪伤机制，闭塞性损伤,受威胁的气道，收缩压<90mmHg,血管损伤的硬迹象，低GCS，昏迷,显示梗塞的CT脑,高损伤严重程度评分和休克指数,低pH或HCO3和乳酸升高是死亡的重要独立预后因素.所有严重神经功能缺损患者的结扎均无法存活，而再灌注手术导致63%(12/19)的昏迷患者和78%(7/9)的LS患者存活，尽管卒中发生率很高(昏迷:25.0%,LS：85.7%）。
结论：PCAI的结果，包括严重的神经功能缺损和中风患者，再灌注时更好。再灌注具有生存的最佳希望，结扎应保留用于技术上无法进入的出血损伤。
