Management of carotid artery trauma

We have treated 45 patients with carotid artery injuries--33 caused by penetrating wounds and 12 secondary to blunt trauma. Preoperative angiography is useful in stable patients to rule out associated vascular injuries, and it is crucial for operative planning in cases of blunt trauma. Not unexpectedly, the results of carotid artery repair in neurologically stable patients have been excellent, as have been the results of revascularization in patients with equivocal or less-severe neurologic deficits. This has led us to be aggressive in repair of carotid artery injuries in patients with questionable neurologic deficits. In the eight patients with severe preoperative deficits, one death each followed both ligation and repair, but neurologic improvement was noted in several patients. Distal internal carotid injuries at the base of the skull that were not amenable to direct repair were observed with serial angiograms in four patients with either stabilization or improvement in the intimal injury.