Management of carotid artery injuries: Louisiana State University Shreveport experience.
BACKGROUND
Traumatic carotid artery injury is an infrequently encountered surgical entity. Carotid artery injuries in polytrauma patients can be easily missed in the absence of clinical findings and/or presence of confounding concurrent injuries.


METHODS
Between 1991 and 1998, 23 patients were diagnosed with various carotid artery injuries at the trauma center of Louisiana State University Health Sciences Center, Shreveport, Louisiana. Injuries were assessed by angiography and/or surgical exploration of the neck. Clinical presentations, radiologic features, management strategies, and neurologic outcomes were statistically analyzed and compared with the existing literature.


RESULTS
Twelve patients (52%) had penetrating carotid artery injuries, while 11 (48%) had blunt trauma. The diagnosis of carotid injury was significantly delayed in the group with blunt trauma as opposed to those with penetrating wounds. Surgical repair was performed in 6 (26%) patients; 2 (8%) underwent balloon occlusion, while ligation was conducted in 2 (8%) patients. Thirteen patients (57%) were treated conservatively with anticoagulants. Six patients (26%) died, while another 6 (26%) had permanent neurologic deficit. Mortality and morbidity was significantly higher in the group with penetrating injuries. A statistical analysis showed that multi-level carotid injury (p < 0.002) and increasing age (p < 0.001) had a significantly higher mortality.


CONCLUSIONS
Injury to carotid arteries results in significant mortality and morbidity. Our results indicate that penetrating carotid injury at more than one level carries higher mortality and morbidity rates than blunt injury. Furthermore, early identification of the injured segment may favorably influence the outcome for such patients.
Nanda
Anil
A
Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, 1501 Kings Highway, PO Box 33932, Shreveport, LA 71130-3932, USA.
Vannemreddy
Prasad S S V
PS
Willis
Brian K
BK
Baskaya
Mustafa K
MK
Jawahar
Ajay
A
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D020212:Carotid Artery Injuries / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008145:Louisiana; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors