Management of carotid artery injuries

Sixty patients with common or internal carotid artery injuries were reviewed. Indications for surgery included hemorrhage, hematoma, presence of a bruit, pulse discrepancy, proximity of wound, and positive arteriography. The patients were divided into three groups according to their neurologic status prior to surgery. Six of 41 patients with no preoperative neurologic symptoms developed a postoperative deficit. Five of six patients with mild deficits prior to operation had complete recovery. Four of 13 patients with severe deficits prior to operation died. The over-all mortality rate was 8.3 per cent. It is suggested from this series that vascular repair may be undertaken with reduced risk to the patient presenting with a mild neurologic deficit in the absence of a frank stroke. When the injury is accompanied by a severe neurologic deficit, it is important to assess the carotid flow. Operative arteriography is very helpful in these patients. Restoration of flow in a patient with a severe neurologic deficit may be hazardous and an anemic infarct may become hemorrhagic. If the arterial injury is accompanied by a cerebral infarct, it is probably advisable to ligate rather than repair the artery.