Carotid Artery Injuries Caused by Blunt Trauma

Carotid artery injuries caused by blunt trauma often cause thrombosis and delayed neurologic deficits, and are associated with mortality rates of up to 40%. In this series of 17 patients with blunt trauma of the carotid, three had no symptoms, ten patients had limb paresis and four had severe neurologic deficits. The wounds were identified by arteriography; repair was attempted in 15 patients, and successful in eight. All eight patients with successful repair were improved or normal after surgery, but only two out of nine patients without repair improved, and four died. The mortality rate for the series was 23%, but only 14% in the patients who had carotid surgery. This experience suggests that repair is safe and effective in patients with carotid injuries in whom prograde flow continues and only mild neurologic deficits are present. In contrast, patients with complete occlusion, severe neurologic problems, and altered consciousness are not likely to be helped by attempts at revascularization.