title: Blunt carotid artery injuries: difficulties with the diagnosis prior to neurologic event.
abstract: OBJECTIVE
  To evaluate the incidence, timing of diagnosis, clinical factors for adverse outcome, and role of anticoagulant, surgical therapy, or endovascular intervention for patients with blunt carotid artery injury (BCAI).
  
  
  METHODS
  Retrospective review of the records of patients who sustained BCAI between 1987 and 1997.
  
  
  RESULTS
  There were 18 men and 12 women, with an average age of 29 years. The diagnosis of BCAI was initially suspected in 15 patients after a major or new neurologic event, and in 15 patients after changes were shown by computed tomography. BCAI was confirmed by arteriography in 29 patients and by magnetic resonance angiography in 1 patient. Treatment consisted of antiplatelet therapy (n = 9), anticoagulation (n = 8), surgical repair (n = 6), observation (n = 4), and endovascular embolization (n = 3). With some type of treatment, 14 patients with no neurologic deficits remained stable; however, treatment improved the final neurologic outcome in 8 patients (20%). Three patients remained with severe deficits, and five patients died.
  
  
  CONCLUSIONS
  The consequences of BCAI may be devastating. In our study, there were no reliable means to suspect this injury before neurologic symptoms or abnormalities show on computed tomographic scan. Although external signs are occasionally helpful, most patients have no pattern of injury to suggest BCAI. For patients whose findings after neurologic examination do not correlate with those on the computed tomographic scan, an immediate angiogram is indicated. Occasionally, a proximal injury can be surgically repaired, but in most patients, anticoagulation therapy appears to be the best treatment to avoid or improve neurologic deficits.
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, University of Louisville Hospital, Center for Advanced Surgical Technologies, KY 40292, USA. ehcarr01@ulkyvm.louisville.edu
authors.forename: E H
authors.initials: EH
authors.lastname: Carrillo
authors.forename: D L
authors.initials: DL
authors.lastname: Osborne
authors.forename: D A
authors.initials: DA
authors.lastname: Spain
authors.forename: F B
authors.initials: FB
authors.lastname: Miller
authors.forename: S O
authors.initials: SO
authors.lastname: Senler
authors.forename: J D
authors.initials: JD
authors.lastname: Richardson
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001927:Brain Diseases / Q000209:etiology / Q000628:therapy; D020212:Carotid Artery Injuries; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy