Emergency endovascular management of penetrating gunshot injuries to the arteries in the face and neck

A case series and review of the literature

Steven M. Yevich, Stephen Robert Lee, Bradford G. Scott, Hashem Shaltoni, Michel E. Mawad, Goetz Benndorf

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction: Penetrating gunshot injuries (GSI) to supra-aortic arteries that cause life-threatening blood loss or major neurologic deficits are increasingly managed using modern endovascular treatment (EVT). We report our experience with EVT of acute GSIs and review the existing literature. Methods: Emergency EVT was performed in nine of 10 patients (7 men, age 17-50 years) with acute GSIs to supra-aortic arteries requiring acute management. One patient presented with acute and delayed injuries and underwent EVT 4 weeks after initial admission. Patient selection was based on clinical presentation and radiographic findings from a cohort of 55 patients with GSIs to the face, neck or head between February 2009 and March 2012. Results: EVT was successfully performed in all patients. Two transections of the vertebral arteries were embolized with coils and/or liquid embolic agent (acrylic glue). Eight penetrated external carotid artery branches were occluded with liquid embolic agents (acrylic glue or Onyx) or particles. One severe dissection of the internal carotid artery with a subsequent thromboembolic event was treated with stenting. All except one patient survived with minor or no residual deficits. Conclusions: Emergency management of GSI injuries to the head and neck may involve all aspects of current EVT. Understanding endovascular techniques and being able to make rapid and appropriate treatment decisions in the setting of acute GSI to the face and neck can be a life-saving measure and greatly benefits the patient's outcome.

Original languageEnglish (US)
Pages (from-to)42-46
Number of pages5
JournalJournal of NeuroInterventional Surgery
Volume6
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Emergencies
Neck
Arteries
Wounds and Injuries
Adhesives
Therapeutics
Internal Carotid Artery Dissection
Neck Injuries
External Carotid Artery
Endovascular Procedures
Emergency Treatment
Vertebral Artery
Neurologic Manifestations
Craniocerebral Trauma
Patient Selection
Head

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Emergency endovascular management of penetrating gunshot injuries to the arteries in the face and neck : A case series and review of the literature. / Yevich, Steven M.; Lee, Stephen Robert; Scott, Bradford G.; Shaltoni, Hashem; Mawad, Michel E.; Benndorf, Goetz.

In: Journal of NeuroInterventional Surgery, Vol. 6, No. 1, 01.01.2014, p. 42-46.

Research output: Contribution to journalArticle

Yevich, Steven M. ; Lee, Stephen Robert ; Scott, Bradford G. ; Shaltoni, Hashem ; Mawad, Michel E. ; Benndorf, Goetz. / Emergency endovascular management of penetrating gunshot injuries to the arteries in the face and neck : A case series and review of the literature. In: Journal of NeuroInterventional Surgery. 2014 ; Vol. 6, No. 1. pp. 42-46.
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