Blunt carotid injury with thrombotic occlusion: Is an intervention always required for best outcome?

Abstract

Blunt cerebrovascular injuries are rare, comprises of 0.08 to 0.33% of all traumatic blunt injuries. Depending on the grade of severity, they may heal with minimal consequences or may lead to debilitating and devastating stroke. Surgically accessible lesions are infrequent and hence endovascular management is preferred modality for high-grade lesions. We hereby present a case of complete thrombosis of the common carotid artery, which couldn't receive either surgical or endovascular treatment due to low resource settings. The patient developed a stroke after 18 h of trauma, which, however, recovered completely and dramatically within 96 h. To the best of our knowledge, such rapid and complete recovery from stroke secondary to blunt carotid injury managed non-operatively hasn't been reported in literature so far. Our report adds to the scarce but growing body of evidence recommending conservative management in BCVI in absence of enlarging pseudoaneurysm and dissection with near-complete stenosis.

Interdisciplinary Successful Revascularization of Traumatic Occlusion of the Right Common Carotid Artery

“…Due to the high rates of stroke in patients with grade IV lesions, intervention is advocated, whether surgical or interventional radiological [ 17 ]. In addition, a large-scale multicenter study done by Jacob-Brassard et al described that carotid intervention in patients suffering from neurological deficits is associated with an increased likelihood of home discharge [ 10 ].…”

How Can We Manage Penetrating Neck Injury with Blunt Carotid Injury and Spinal Injury: Case Report and Review of Literature

“…Major indications for endovascular stent placement include (1) failed medical management (new ischemic event, the progression of initial symptoms, or enlarging pseudoaneurysm); (2) stroke; and (3) contraindications to anticoagulation. Previously a case report suggests similar conservative management in a stroke patient following blunt carotid injury [15].…”

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

“…The blunt injury of the extracranial ICA begins with intimal damage resulting in dissection, which is the final common pathway for vascular injury. The dissection can be progressive and extend to the distal site, resulting in ICA stenosis/occlusion [14,15].…”