Hybrid Endovascular and Direct Surgical Approach for Treatment of Penetrating Common Carotid Artery Injury: A Case...

Although rare, penetrating cervical vascular injury poses significant challenges with a poor patient prognosis, often attributed to severe hemorrhage and accompanying injuries. We encountered a case of hemorrhagic shock resulting from a penetrating injury to the common carotid artery (CCA), which was successfully managed using a combination of endovascular therapy and direct surgical intervention. A 23-year-old man presented with a self-inflicted stab wound on the left side of his neck from a kitchen knife. This injury resulted in hemorrhagic shock and coma. Initial management included fluid resuscitation and transfusion, with continuous manual compression to control profuse bleeding. Contrast-enhanced neck and brain computed tomography (CT) showed a left CCA injury that was challenging to directly address due to its low anatomical location and continuous bleeding. Neurosurgeons initiated endovascular treatment by placing a guiding balloon catheter proximal to the left CCA for occlusion. Despite this, pulsatile bleeding persisted, prompting the distal placement of a balloon catheter to achieve better bleeding control. Cardiovascular surgeons then performed direct surgery, clearly identifying damage to the anterior and posterior walls of the CCA. The repair involved the use of a self-made cylindrical bovine pericardial patch, which resulted in successful revascularization. Following surgery, the patient regained independent mobility and was discharged. This case emphasizes the importance of a prompt and reliable approach involving endovascular intervention for initial bleeding control followed by precise repair through direct surgery, especially in challenging bleeding scenarios.