Carotid artery trauma: A review of contemporary trauma center experiences
Ramadan, F.; Rutledge, R.; Oller, D.; Howell, P.; Baker, C.; Keagy, B.
Journal of Vascular Surgery 21(1): 46-55; discussion 55-6
Purpose: Many issues surrounding the management and outcome of carotid artery injuries remain controversial. The purpose of this study was to review a large contemporary experience with such injuries in the setting of designated trauma centers. Methods: A statewide computerized trauma registry was used to identify all patients with injuries to the common or internal carotid arteries from October 1987 to June 1993. The records of 82 such patients were retrieved and analyzed. Results: Overall mortality and stroke rates were 17% and 28%, respectively. Patients presenting with coma or shock had a particularly bad prognosis (50% and 41% mortality, respectively). Internal carotid injuries resulted in mortality and stroke rates of 21% and 41%, respectively, compared with 11% each for common carotid injuries. Patients with blunt injuries had a much higher stroke rate (56% vs 15%) but had lower mortality (7% vs 22%) than did patients with penetrating injuries. Airway compromise and associated injuries did not affect prognosis. Operative repair and percutaneous balloon occlusion had the best survival and functional outcomes. Conclusions: Operative repair offers the best chances for recovery in all categories of patients regardless of injury mechanism. Ligation is useful only as a last-resort lifesaving effort. Shock and neurologic impairment are poor prognostic factors but should not negate repair.