{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:57:56Z","timestamp":1788782276417,"version":"build-2803163510"},"reference-count":24,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,6,23]],"date-time":"2024-06-23T00:00:00Z","timestamp":1719100800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from three large urban trauma centers in South Africa were retrospectively reviewed for patients who presented with PCAI from 2012 to 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 149 identified patients, 137 actively managed patients were included. Twenty\u2010four 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 &lt;90\u00a0mmHg, 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%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/wjs.12252","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T01:58:20Z","timestamp":1719194300000},"page":"1848-1862","source":"Crossref","is-referenced-by-count":4,"title":["Outcomes of penetrating carotid artery injuries: A South African multicentre study"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5361-2834","authenticated-orcid":false,"given":"Andre Steiner","family":"Madsen","sequence":"first","affiliation":[{"name":"Department of Surgery University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deirdre","family":"Kruger","sequence":"additional","affiliation":[{"name":"Department of Surgery University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damian Luiz","family":"Clarke","sequence":"additional","affiliation":[{"name":"Department of Surgery Pietermaritzburg University of KwaZulu\u2010Natal  Pietermaritzburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5152-3317","authenticated-orcid":false,"given":"Pradeep","family":"Navsaria","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8903-0510","authenticated-orcid":false,"given":"Matthias","family":"Scriba","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanda","family":"Bekker","sequence":"additional","affiliation":[{"name":"Department of Surgery Pietermaritzburg University of KwaZulu\u2010Natal  Pietermaritzburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maeyane Steve","family":"Moeng","sequence":"additional","affiliation":[{"name":"Department of Surgery University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,23]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00068\u2010011\u20100132\u20103"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0741\u20105214(95)70243\u20101"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0741\u20105214(03)00143\u20105"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/ta.0000000000002755"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2020.03.013"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/ta.0b013e31824badf7"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1457496917731187"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2009.05.003"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2010.09.022"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0002\u20109610(70)80113\u20101"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373\u2010197303000\u201000012"},{"issue":"6","key":"e_1_2_12_13_1","first-page":"955","article-title":"Management of Carotid Artery Injuries","volume":"76","author":"Thal E. 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