EXTRA-CRANIAL CAROTID-ARTERY INJURIES

  • 1 January 1980
    • journal article
    • research article
    • Vol. 88  (4) , 581-587
Abstract
Of 54 carotid artery injuries treated, 78% were due to gunshot wounds, 20% to stab wounds and 2% secondary to blunt trauma. About 33% involved the internal carotid artery, and the external carotid artery was involved in 20%. Of the patients, 18% presented with a major associated venous injury and 8% with an arteriovenous fistula. Partial or complete disruption accounted for the majority of injuries. There was a 10% mortality rate. Of the deaths, 4% were due directly to carotid vascular trauma. All patients should have the benefit of preoperative arteriography. This allows for a well planned operation and avoids major unnecessary neck dissection. High lesions involving the internal carotid artery may be exposed easily by anterior dislocation of the jaw, allowing ready access to the skull base. Injuries involving extensive areas of the internal carotid artery (lesions extending intracranially) are best managed by extracranial-intracranial (EC-IC) bypass with internal carotid artery ligation. Severe neurologic deficit is best treated by ligation of the carotid artery. Seven patients underwent EC-IC bypass; 86% of these returned to or maintained normal neurologic status, while the other 14% remained neurologically stable. The risk of neurologic deficit evidently is lessened by this maneuver without added mortality or morbidity.

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