Recent Trends and Outcomes of Traumatic Carotid Artery Injury in Adults from the National Trauma Data Bank

Objectives Surgical management of carotid artery injury is performed via open repair/ligation or endovascular techniques. We hypothesize that there has been a shift towards endovascular repair for blunt and penetrating injuries with non-inferior outcomes and complications. Methods The National Trauma Data Bank from 2017-2022 was queried for carotid artery injuries based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. We included patients ≥18 years old who underwent open (OR) or endovascular repair (ER) and studied temporal trends, comparative analysis, multivariate modeling, and interaction testing for blunt (BCAI) and penetrating carotid artery injury (PCAI). Results From 2017 to 2022, 21,539 TCAIs were identified, with the annual proportion increasing from 0.25% to 0.39% (p < 0.001). Among 19,874 adult patients, 748 underwent intervention: 444 (59.3%) open repairs (OR) and 304 (40.7%) endovascular repairs (ER). BCAI predominated in the ER group, whereas PCAI was more common in OR (p < 0.001). Multivariate analysis demonstrated a nonsignificant increase in ER over the study time (p = 0.11). In the unadjusted analysis, ER was associated with significantly higher rates of post-procedural stroke compared with OR for both BCAI (19.5% vs 8.8%; p=0.018) and PCAI (22.2% vs 10.6%; p=0.011). After adjusting for age, Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) via logistic regression, ER remained a strong independent predictor of post-procedural stroke (odds ratio 2.024; 95% CI, 1.035-3.162; p=0.002). Intervention type did not significantly predict mortality (p = 0.17). In a 1:1 propensity score-matched analysis of 326 patients, in-hospital mortality (p = 0.51) and hospital length of stay (p = 0.09) were comparable between groups. However, the incidence of post-procedural stroke remained significantly higher in the ER cohort (20.2% vs 9.2%; p=0.005). Conclusions There has been an increase in TCAI from 2017-2022. Most cases were managed non-operatively. There has been a nonsignificant shift towards ER based on adjusted analysis, however, ER carries nearly twice the rate of stroke compared to OR in all TCAI, BCAI, and PCAI.