Neurologic outcome after penetrating extracranial arterial trauma

Abstract

The presence of hypovolemic shock, internal carotid artery injury, complete vessel transection, and arterial ligation are associated with unfavorable outcome. Penetrating injury to the brachiocephalic, common carotid, or internal carotid artery should be repaired rather than ligated when technically possible. Subsequent ischemic or hemorrhagic cerebral infarction is unpredictable, but overall outcome is superior to that with ligation of the injured artery.

Emergent Surgical Repair for Penetrating Injury of the Cervical Carotid Artery Associated With Shock -Case Report-

“…4,7,8) Among 30 patients with penetrating carotid artery injury presenting with shock or coma, 3 of 4 patients with shock died, despite surgical repair of the injured vessel, and 19 of 26 patients with coma died. 2) In our patient, no presurgical radiological evaluation was possible because he had profuse bleeding from the wound, so continuous manual compression was essential. Manual compression was continued until the proximal common carotid artery was secured.…”

Common Carotid Artery Laceration Managed by Clamping at Emergency Department

“…In case of devascularization to brain due to the injury of carotid artery, central neurologic deficit is a main concern after operation and revascularization may cause stroke as well. In the penetrating extracranial carotid artery trauma patients, mortality was 21.2% and stroke rate after survival was 15.1% [10]. Of course, the collateral circulation between vertebral artery and subclavian artery is well known [11].…”

Successful Surgical Repair of Transected Common Carotid Artery after 12 Hours from Trauma

“…Existence of retrograde blood flow is a very important indicator for reconstructive surgery of the traumatized carotid artery. Toit et al (5). described the indications of carotid ligation.…”

“…However, the carotid artery should be ligated in comatose patients, critical unstable patients or difficult-to-repair lesions (9,11). For traumatic distal internal carotid artery occlusion in neurologically intact patients, it should be managed by anticoagulation alone or as adjunctive ligation (5). Stent-graft treatment is considered in selected patients with a proximal lesion (requiring sternotomy) or distal internal carotid artery injury.…”

“…Stent-graft treatment is considered in selected patients with a proximal lesion (requiring sternotomy) or distal internal carotid artery injury. The bleeding, intraluminal clot, compression symptoms caused by hematoma, concomittent injuries needing exploration, and infected wounds as relative contraindications (5). This therapeutic method may in future be more extensively applied in selected patients, especially with newly developed adjunctive neurologic protection devices (11,12).…”