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Endovascular Embolization of Traumatic Vessel Injury Using N-butyl Cyanoacrylate: A Case Series

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Abstract

There is limited evidence of N-butyl cyanoacrylate (n-BCA) use in endovascular embolization of traumatic face and neck vessel injuries. We investigated the safety and effectiveness of n-BCA for this purpose. We retrospectively analyzed consecutive patients presenting to a Level 1 trauma center between April 2021 and July 2022. We included patients aged ≥ 18 years old with any vessel injury in the face and neck circulation requiring n-BCA embolization. The primary endpoint was n-BCA effectiveness defined as immediate control of active bleeding post-embolization. In total, 13 patients met the inclusion criteria. The median decade of life was 3 (IQR 3 – 5) with a male predominance (n = 11, 84.6%). Median Glasgow Coma Scale score on presentation was 15 (IQR 3–15). Eleven patients suffered gunshot wound injuries; two patients suffered blunt injuries. Injured vessels included facial artery (n = 6, 46.2%), buccal branch artery (n = 3, 23.1%), internal maxillary (n = 5, 38.5%), cervical internal carotid artery (n = 1, 7.7%), and vertebral artery (n = 1, 7.7%). All patients were treated with 1:2 n-BCA to ethiodol mixture with immediate extravasation control. No bleeding recurrence or need for retreatment occurred. One patient died in-hospital (7.7%). Patients were discharged to home (n = 8, 61.5%), day rehabilitation (n = 1, 7.7%), or acute rehabilitation (n = 3, 23.1%). One patient developed a right posterior cerebral artery infarct with hemorrhagic transformation. To our knowledge, this is the first study demonstrating the safety and effectiveness of n-BCA liquid embolism in traumatic vessel injuries, especially penetrating gunshot wounds.

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Data Availability Statement

Additional data are available upon request from the corresponding author.

Abbreviations

CT:

Computed tomography

GSW:

Gunshot wound

n-BCA:

N-butyl cyanoacrylate

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Acknowledgements

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This study was not funded.

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Author notes

  1. Rami Z. Morsi and Archit Baskaran have contributed equally to this study.

Authors and Affiliations

  1. Department of Neurology, University of Chicago, 5841 S Maryland Ave., MC 2030, Chicago, IL, USA

    Rami Z. Morsi, Archit Baskaran, Sonam Thind, Julián Carrión-Penagos, Harsh Desai, Sachin A. Kothari, Christos Lazaridis, Fernando Goldenberg, Scott J. Mendelson, Shyam Prabhakaran, Ali Mansour & Tareq Kass-Hout

  2. Cerenovus (Johnson & Johnson), Galway Neuro Technology Center, Galway, Ireland

    Mahmood Mirza

  3. Department of Radiology, University of Chicago, Chicago, IL, USA

    Michael C. Hurley

  4. Department of Surgery, University of Chicago, Chicago, IL, USA

    Tanya Zakrison

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All authors participated in the research, data collection, provision of critical revisions for content, and/or writing of the manuscript, and all authors approved the final version of the manuscript.

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Correspondence to Tareq Kass-Hout.

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The protocol of this study was approved by the Institutional Review Board, and the need for informed consent was waived.

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Morsi, R.Z., Baskaran, A., Thind, S. et al. Endovascular Embolization of Traumatic Vessel Injury Using N-butyl Cyanoacrylate: A Case Series. Indian J Otolaryngol Head Neck Surg 76, 1554–1562 (2024). https://doi.org/10.1007/s12070-023-04357-1

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