Blunt carotid artery injury

Abstract

Blunt carotid artery injury is an uncommon injury with a potentially devastating outcome. Although treatment is often unhelpful for an established neurologic deficit, there is frequently a delay between the episode of trauma and the onset of neurology. This delay provides a window of opportunity where early detection and intervention may significantly improve outcome and prevent lifelong morbidity in a generally young trauma patient population. This paper will review the literature regarding incidence, outcome, treatment options and optimal methods of diagnosis for this lesion. The following synopsis of a case seen at Royal Perth Hospital Emergency Department illustrates several of the classical features of blunt carotid injury, including delayed presentation and pattern of associated injuries. The patient, a 19‐year‐old female, presented following a single vehicle motor crash. On arrival she had a Glasgow Coma Scale (GCS) of 14 with no focal neurologic deficit. Multiple injuries were identified, including a large scalp laceration, a compound fracture of the mandible, pneumothorax, sternal fracture, subcapsular haematoma of the liver, and a knee laceration. Initial computed tomography (CT) scan of the head was normal. Twenty hours after the motor vehicle accident the patient's conscious state deteriorated to GCS 9. Repeat CT head demonstrated changes consistent with a left middle cerebral artery infarct. Cerebral angiography revealed traumatic dissection of the left internal carotid artery with complete occlusion of the lumen just distal to its origin. After 13 days in the intensive care unit and 2.5 months in the rehabilitation unit, she was discharged with a persistent severe receptive and expressive aphasia, as well as a dense right hemiparesis. She is now living at home with community supports.

Evaluation of Neck Vessel Injury in Patients with Blunt Trauma to the Cervical Spine

“…A review of the literature done in 2002 showed a combined moderate and severe permanent neurologic deficit approximating 25 to 40% in survivors. 17 Mortality varies from 15 to 40%. Patients with an ipsilateral ischemic deficit on CT of the brain suffered a mortality of 47%, whereas mortality was 0% in those with a normal CT scan.…”

Concurrent Carotid Rupture and Coronary Dissection After Blunt Chest Trauma

“…10 Symptoms in the awake patient include head or neck pain (75% of cases) or ipsilateral Horner's syndrome (50% of cases), but the onset of symptoms can vary between hours and weeks after carotid artery injury. 12,13 In the multiply injured and anesthetized patient, symptoms are usually absent or masked. Only specific screening examinations may lead to early diagnosis before the occurrence of cerebral ischemia or stroke.…”

Endovascular treatment of blunt injury of the extracranial internal carotid artery: the prospect and dilemma

“…For extracranial ICA blunt injury, there are several classifications, such as the Biffl scale, Borgess classification, and Seth supplemental classification to Biffl [24][25][26][27].…”

“…However, for blunt carotid arterial injuries, the Borgess classification is limited. Currently, the Biffl et al scale is commonly utilized to assign vascular injuries and has become the standard for extracranial ICA blunt injury, from grade I to V as follows: grade I, irregularity or dissection with <25% stenosis; grade II, dissection with >25% luminal narrowing or a raised intimal flap; grade III, pseudoaneurysm; grade IV, complete occlusion; and grade V, ICA transection, active contrast extravasation [25,26].…”