Management and outcomes of penetrating traumatic carotid injuries

Carotid artery injuries carry a high risk of morbidity and mortality. Owing to their variable presentation, management paradigms are not standardized. Our goal was to report the outcomes of penetrating carotid artery injuries.

All patients over the age of 18 with penetrating common carotid artery or internal carotid artery injury between 2010 and 2021 were retrospectively identified from our prospectively maintained database.

Forty-six patients were identified. The median patient age was 29 years. The majority were male (82.6%) and Black (80.4%). Sixteen of the 46 patients with penetrating injuries presented neurologically intact. Ten underwent operative repair with one having a new neurological deficit; six were managed conservatively with one new neurological deficit. Thirty of the 46 patients with a penetrating injury presented with neurological deficits. Of the 23 managed operatively, 9 had a stroke, 6 improved neurologically, and 8 died (3 from other injuries). Only seven penetrating injuries were treated medically: one had a stroke, four improved, and two died from other injuries. Overall, 12 patients had a new stroke. Factors not significantly associated with stroke included age, Injury Severity Score, time to repair, sex, artery involved, and operative vs medical management. Presence of avulsion/transection was found to be significantly associated with stroke (odds ratio, 5.40; 95% confidence interval, 1.26-23.2; P = .0024).

Patients who present with avulsion or transection of the carotid artery after penetrating trauma have a significant risk of stroke. This risk is not significantly associated with the mechanism of injury or subsequent management. Patients who present neurologically intact rarely deteriorate regardless of treatment.