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Review
. 2014 Sep;7(3):175-89.
doi: 10.1055/s-0034-1372521.

Management of carotid artery trauma

Thomas S Lee  1 , Yadranko Ducic  2 , Eli Gordin  3 , David Stroman  4
Affiliations
Review

Management of carotid artery trauma

Thomas S Lee et al. Craniomaxillofac Trauma Reconstr. 2014 Sep.

Abstract

With increased awareness and liberal screening of trauma patients with identified risk factors, recent case series demonstrate improved early diagnosis of carotid artery trauma before they become problematio. There remains a need for unified screening criteria for both intracranial and extracranial carotid trauma. In the absence of contraindications, antithrombotic agents should be considered in blunt carotid artery injuries, as there is a significant risk of progression of vessel injury with observation alone. Despite CTA being used as a common screening modality, it appears to lack sufficient sensitivity. DSA remains to be the gold standard in screening. Endovascular techniques are becoming more widely accepted as the primary surgical modality in the treatment of blunt extracranial carotid injuries and penetrating/blunt intracranial carotid lessions. Nonetheless, open surgical approaches are still needed for the treatment of penetrating extracranial carotid injuries and in patients with unfavorable lesions for endovascular intervention.

Keywords: blunt carotid artery trauma; endovascular repair; extracranial carotid artery trauma; internal carotid artery; intracranial cartoid artery trauma; open repair; penetrating carotid artery trauma.

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Figures

Figure 1
Figure 1
Segmental classification of internal carotid artery.
Figure 2
Figure 2
An updated screening criteria from the Denver group and their management algorithm. Although CTA is recommended as the initial screening modality of choice in this algorithm, there is controversy regarding CTA's insufficient sensitivity. Some authors recommend DSA as the initial screening modality of choice instead. Most authors strongly recommend antithrombotic therapy if there is no contraindication. Surgical decision making is individualized for each patient and is not strictly dependent on the injury grading system. CTA, computed tomography angiography; DSA, digital subtraction angiography.
Figure 3
Figure 3
(A) A grade I lesion identified as a luminal narrowing of the left common carotid is seen on the reconstructed CTA. (B) DSA demonstrates progressive worsening of the common carotid injury. (C) Endovascular intervention with a stent was placed successfully. The arrows indicate the site of grade I carotid injury before and after endovascular stenting. CTA, computed tomography angiography; DSA, digital subtraction angiography.
Figure 4
Figure 4
A grade II lesion with a significant luminal irregularity (≥ 25%) of the internal carotid artery can be seen as marked by the arrow.
Figure 5
Figure 5
A grade III lesion with a pseudoaneurysm of the ICA is demonstrated in the DSA. The arrow points to the psuedoaneurysm. DSA, digital subtraction angiography; ICA, intracranial carotid artery.
Figure 6
Figure 6
A grade IV lesion with occlusion of the ICA is seen in the CTA as marked by the arrow. CTA, computed tomography angiography; ICA, internal carotid artery.
Figure 7
Figure 7
A grade V lesion with frank extravasation of contrast from the transected internal carotid artery. The arrow marks the contrast extravasation.
See this image and copyright information in PMC

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