Exploring penetrating carotid Injuries: Low grade, low yield?

Area of Science:

• Vascular Surgery
• Trauma Management
• Diagnostic Imaging

Background:

• The necessity of surgical intervention for low-grade penetrating carotid injuries remains debated.
• Current guidelines lack clarity on optimal management strategies.

Purpose of the Study:

• To compare outcomes between non-operative and operative management of low-grade penetrating carotid injuries.
• To evaluate the safety and efficacy of non-operative approaches.

Main Methods:

• Retrospective review of 54 patients with 62 low-grade penetrating injuries (intimal dissections, intramural hematomas) of the common carotid artery (CCA) and internal carotid artery (ICA).
• Comparison of outcomes for patients managed non-operatively versus operatively.
• Data collected from January 2012 to December 2023.

Main Results:

• Operative management (10 patients) primarily involved non-therapeutic vascular explorations (90%).
• One death occurred in the operative group due to neurologic decline.
• No deaths or strokes were reported in the non-operative group (44 patients).
• Stroke rates were comparable between both management groups.

Conclusions:

• Non-operative management of low-grade penetrating carotid injuries is a safe alternative with similar stroke rates to operative repair.
• CT imaging is recommended for stable patients with penetrating neck trauma to accurately characterize injuries.
• Non-operative management may avoid unnecessary surgical interventions and associated risks.