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Video

Care Equity, Quality, and Safety

(A132) Modified TEAM-ICA Protocol for Management of ICA Injury in Endoscopic Sinus Surgery

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Akshaya Raman, BA

    Medical Student
    University of Pittsburgh School of Medicine
    Pittsburgh, Pennsylvania, United States

    • Senior Author(s)

  • Carl H. Snyderman, MD, MBA

    Professor of Otolaryngology and Neurological Surgery
    University of Pittsburgh School of Medicine
    Pittsburgh, Pennsylvania, United States

Disclosure(s):
Akshaya Raman, BA: No relevant relationships to disclose.
Carl H. Snyderman, MD, MBA: No relevant relationships to disclose.


Introduction: Internal carotid artery (ICA) injury during endoscopic sinus surgery (ESS) is a rare but devastating complication that requires coordinated, interprofessional management. In contrast to skull base surgeries, ESS has a single otolaryngologist operator and comparatively fewer resources present. This study reviews ICA injury cases in ESS and proposes modifications to the TEAM-ICA (Targeted Education and Advanced Management for ICA Injury) skull base surgery curriculum/management protocol to improve education and emergency response.

Methods: A literature review of documented ICA injuries in ESS (dating from 1988 to 2021) was conducted, analyzing risk factors, management strategies, outcomes, and multidisciplinary coordination. Key themes in successful cases were identified to refine the TEAM-ICA curriculum, aligning it with the resources available to otolaryngologists during ESS.

Results: Successful management of ICA injury in ESS consistently involved preoperative CT angiography to identify high-risk anatomical variants, prompt hemostasis via nasal packing, and early neurovascular intervention. Optimal outcomes were achieved when interventional radiology (IR) was engaged early for endovascular stenting, coiling, or balloon occlusion. ESS instrument sets lack tools for direct vascular repair, necessitating a damage-control approach focused on packing, blood pressure optimization, and rapid transfer to neurovascular centers.

Conclusions: TEAM-ICA modifications for ESS emphasize preoperative risk stratification and imaging, structured hemostatic techniques, and defined referral pathways, ensuring sinus surgeons can respond effectively. While ICA injury during endoscopic sinus surgery is rare, its occurrence can be catastrophic, making thorough preparation essential for optimal patient outcomes. Modifying the TEAM-ICA protocol to train otolaryngologists and OR teams in managing ICA injuries without immediate neurosurgical support is critical to improving response times, reducing complications, and ensuring better overall patient safety.