Trauma to the high cervical carotid artery

Area of Science:

• Vascular Surgery
• Neurosurgery
• Trauma Management

Background:

• Penetrating injuries to the distal extracranial internal carotid artery (ICA) present complex treatment challenges.
• Traditional management often involves surgical repair or bypass, but ligation is an alternative approach.

Observation:

• A case involving a penetrating injury to the distal extracranial ICA is presented.
• Initial management involved ligation of the injured ICA, followed by expectant observation.
• A transient neurologic deficit occurred, prompting an attempt at revascularization.

Findings:

• Revascularization via superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis was unsuccessful.
• The failure was attributed to a post-injury hypercoagulable state.
• Additionally, a robust development of collateral blood supply reduced the demand for intracranial blood flow, potentially contributing to anastomosis failure.

Implications:

• Internal carotid artery ligation can be a successful treatment for specific penetrating injuries.
• Hypercoagulable states and well-developed collateral circulation are critical factors to consider in managing post-ligation complications and revascularization attempts.
• This case highlights the importance of assessing collateral flow before and after surgical intervention in traumatic carotid artery injuries.