Blunt carotid artery injury: difficult therapeutic approaches for an underrecognized entity

To assess the damage inflicted by carotid artery injuries, to attempt to explain some differences between published series, and to summarize the management of different types of lesions.

Retrospective analysis of patients treated for nonpenetrating injury of the carotid arteries in our hospital from 1985 to 1991.

Seven patients (all men, with ages ranging from 19 to 55 years) had eight injuries to the carotid arteries. One patient was asymptomatic; another patient had neurologic symptoms unrelated to the carotid artery injury; severe neurologic deficits developed in the remaining five patients, of whom three died. Symptoms occurred immediately in one patient, after a few days in two patients, and after a few weeks in two patients. Arterial damage included dissection (four cases), pseudoaneurysm (two cases), local contusion (one case), and occlusion (one case). Surgical treatment consisted of aneurysmorraphy and extraintracranial bypass in one patient each. Surgical intervention was not considered in the other patients because of the severity of their neurologic symptoms. Besides collective reviews, very few series pertaining to this pathologic condition exist in the literature; however, some report good overall results. These reports comprise a high proportion of asymptomatic cases; the internal injury is usually only discovered incidentally on thoracic aortograms or by scanning the neck during head computed tomography scans.

Nonpenetrating trauma to the carotid arteries carries significant morbidity and mortality rates. Wide-scale screening for carotid lesions in victims of blunt trauma would be necessary to determine the true incidence and gravity of this pathologic condition. A search for carotid artery injury should be performed in patients with a history of neck or head trauma to detect whether the correction of any lesion would lead to improvement or prevention of neurologic deficits.