Salvage endovascular treatment in hybrid operating room for incidental internal carotid artery injury during neurosurgery: a single-center experience.

Incidental injury to the internal carotid artery (ICA) represents a severe complication during neurosurgery, particularly in skull base procedures, and may result in catastrophic intraoperative hemorrhage. The efficacy and safety of endovascular salvage in a hybrid operating room (OR) for hemostasis remain unclear. This study aimed to evaluate the outcomes of endovascular salvage for intraoperative ICA injuries. A retrospective analysis was conducted of patients undergoing endovascular salvage for ICA injury during open neurosurgery and transnasal endoscopic neurosurgery. Antiplatelet regimens and platelet function monitoring results were recorded using the platelet aggregation test (PAgT). Postoperative computed tomography (CT) was performed to assess the presence of intracranial hemorrhage (ICH) and cerebral infarction (CI). Neurological deficits were recorded postoperatively, and self-care ability was evaluated using the modified Rankin Scale (mRS) at follow-up. Fifteen patients (six with pituitary tumors, five with meningiomas, three with chordomas, and one with schwannoma) were included. Sixteen covered stents were successfully implanted in hybrid ORs, achieving immediate hemostasis without post-implantation arterial stenosis or occlusion, as confirmed by digital subtraction angiography (DSA). Severe cerebral infarction occurred in two patients who subsequently fell into a coma and died within seven days after surgery. In addition, no other intracranial hemorrhage or cerebral infarction was detected by the postoperative CT scan. Antiplatelet therapy was initiated within 24 h after stent implantation. PAgT results in four patients showed mean values of 10.16% for PAgT-arachidonic acid, 24.12% for PAgT-adenosine diphosphate, and 28.25% for PAgT-collagen. Among the thirteen surviving patients, there were no additional neurological deficits, and the average mRS score was 0.85 at follow-up. Endovascular salvage using covered stents for ICA injury during neurosurgery in hybrid ORs is feasible and effective. Personalized antiplatelet therapy with platelet function monitoring warrants further investigation.