Natural History and Nonoperative Management of Penetrating Cerebrovascular Injury

Study Overview
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Brief Summary
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The goal of this study is to evaluate a series of cases of penetrating cerebrovascular injury managed without upfront operation. Investigators focus on patient characteristics, injury details, treatment modalities, serial imaging studies, patient outcomes, and complications. Investigators will compare this patient population to patients managed with upfront operation for context.

Detailed Description
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Penetrating cerebrovascular injuries (PCVIs) are uncommon, with little data to guide management when emergent operative repair is not performed. Investigators hypothesized that PCVIs may be managed with antithrombotic therapy and directed use of endovascular interventions, but that PCVIs may require enhanced surveillance due to a risk of delayed complications. To perform this study, investigators will review patients with penetrating carotid and vertebral artery injuries managed at an urban Level I trauma center from 2016 to 2022. Patients will be included if they underwent initial nonoperative management (NOM). Patient characteristics, injury details, treatments, serial imaging, outcomes, and complications will be assessed in a retrospective manner using chart abstraction. Investigators will briefly compare these patients to those managed with upfront operations for context.

Official Title
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Natural History and Nonoperative Management of Penetrating Cerebrovascular Injury

Conditions
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Cerebrovascular Trauma

Intervention / Treatment
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* Other: No intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Penetrating neck trauma Carotid or vertebral artery injury

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Penetrating cerebrovascular injury, managed nonoperatively<br>PCVI from penetrating trauma without upfront operation | Other: No intervention<br>* This study did is a retrospective case series and does not involve an intervention. Investigators will compare patients managed operatively vs nonoperatively, focused on nonoperative therapy.<br>|
| Penetrating cerebrovascular injury, managed operatively<br> | Other: No intervention<br>* This study did is a retrospective case series and does not involve an intervention. Investigators will compare patients managed operatively vs nonoperatively, focused on nonoperative therapy.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| number of patients with stroke | ischemic stroke | up to one year post-injury | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| number of patients with injury progression | CTA progression of PCVI severity (Grade) | up to one year post-injury | 
| number of patients with death | death | up to one year post-injury | 
| number of patients with bleeding complications | intracranial hemorrhage, GI bleed, etc requiring change in treatment | up to one year post-injury | 
| number of patients treated with operative exploration | All patients in cohort are treated with initial trial of nonoperative management. This outcome assesses the number of patients who subsequently required operative neck exploration. This is readily attainable from operative reports. | up to one year post-injury | 
| number of patients treated with arterial embolization or arterial stent placement | IR procedures are adjuncts to nonoperative management. Performance of these procedures is readily attainable from IR procedure reports. | up to one year post-injury | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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penetrating cerebrovascular injury, nonoperative management, penetrating neck trauma, natural history, antithrombotic therapy, case series