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International Young Surgeons Competition

IYSC13 - Early Outcomes of Patients with Traumatic Carotid Injuries Treated Conservatively

Thursday, June 5, 2025
2:30 PM – 2:35 PM CT
Location: Morial CC, Second Floor, Room 224
Objectives: Traumatic carotid injuries constitute a small proportion of all traumatic vascular injuries worldwide, but their burden of disease is substantial due to the high risk of stroke, death, or severe neurological sequelae, particularly in settings with high rates of civilian gun violence.Historically, open surgery has been the treatment of choice.However, endovascular techniques have expanded therapeutic options for these injuries, reducing the risk of stroke and death over the past two decades.Previous studies suggest that medical management for specific carotid injuries may be superior to endovascular and surgical interventions.At our institution, conservative management is preferred in patients with complete artery occlusion without neurological deficits or active bleeding, as well as in arterial dissections measuring less than 5 mm and patients with neurological signs and or syptoms with more than 6 hours upon the injury.This study describes the injury characteristics, treatment, and early prognosis of patients with traumatic carotid injuries managed medically.

Methods: We conducted a descriptive incidence study to analyze the prognosis of patients with carotid injuries treated conservatively at our institution, a level one trauma center in Cali, Colombia, between 2012 and 2024.Injury and clinical characteristics upon admission were recorded.We measured the incidence of stroke, neurological outcomes using the Glasgow Outcome Scale (GOS), and mortality, estimating their 95% confidence intervals.Quantitative variables are presented as medians and interquartile ranges (IQR), while qualitative variables are expressed as counts and proportions.

Results: We identified 97 patients with traumatic carotid injuries, of whom 36(37.1%)were treated conservatively and included in the analysis.Among these, 26 patients (72.2%) sustained penetrating gunshot wounds, while 10(27.8%) suffered blunt trauma.A total of 62.2% had an Injury Severity Score (ISS) ≥15, and 18 patients (50%) had concomitant severe traumatic brain injury (AIS ≥3).Carotid injuries included dissections (32.3%), occlusions (25.8%), lacerations (22.9%), and pseudoaneurysms (19.4%).The median admission systolic blood pressure (SBP) was 118 mmHg (IQR: 97–131).Nine patients (25%) presented with hemiplegia upon admission.The median hospital stay was 5 days (IQR: 3–15), and hospital mortality was 28%(95% CI: 15.1%–44.0%).At discharge, 42.9% of patients achieved good recovery (GOS = 5), and 17.1% had moderate disability (GOS = 4).Cerebral infarction occurred exclusively in the nine patients (25%) who presented with hemiplegia at admission

Conclusions: In patients with carotid trauma, non-operative management represents a safe alternative in specific cases.In our analysis, patients without neurological signs or symptoms at admission showed no evidence of stroke or mortality risk.