Long-term outcomes after endovascular stent-graft repair of traumatic extracranial carotid artery injuries: a single Level I centre retrospective cohort.

Abstract

Preliminary results suggest that placement of stent grafts is a safe method of treating carotid traumatic injuries, but data on late follow-up are limited, therefore this study evaluated in hospital and long-term outcomes of endovascular treatment of carotid artery injuries DESIGN: single centred, retrospective METHODS: This study evaluated patients admitted at University of São Paulo School of Medicine from 2011 to 2024. Complications, mortality, stroke rates and carotid patency were assessed. Sixteen patients underwent endovascular treatment of their carotid artery injuries during the study period. They were male; with a mean age of 34 ± 11 years. Most injuries resulted from penetrating trauma (12 out of 16). At hospital admission, the median Injury Severity Score (ISS) was 13 (IQR 9-18.5), Revised Trauma Score (RTS) was 8 (IQR 6.75-8) and Glasgow Coma Score (GCS) was 15 (IQR 4.25-15) and five patients had neurological deficits. The common carotid artery was the most frequently injured artery (9/16), while pseudoaneurysms constituted the most common type of arterial injury (13/16). Patients underwent endovascular repair of their vascular injuries via stent graft implantation (nine stent grafts were placed in the common carotid artery, three in the carotid bulb and four in the internal carotid artery). There was no intervention related stroke. Eleven patients were discharged in good condition, four patients had neurological impairment (stable comparing to their deficit at hospital admission) and one patient died due to a contralateral haemorrhagic stroke. Ipsilateral stroke-free survival rate was 62 % at hospital discharge. The mean follow-up time was 43.5 months (IQR 16-61.75). The primary patency of the stent grafts was 100 % at 12 months, 83 % at 24 months, and 73 % at 24 months. Three occlusions were reported, all occurring in stent grafts located within the internal carotid artery. these occlusions were asymptomatic. This study highlights the safety of stent graft repair in a selected cohort of patients with carotid injury. It was observed that stent grafts implanted in the internal carotid artery are prone to late, often asymptomatic occlusion, underscoring the importance of surveillance. However, multicentre prospective studies are still needed to establish best practice.