Evolving Strategies for the Management of Carotid Artery Injuries due to Penetrating Trauma

Abstract

Penetrating carotid injuries, although less common than other forms of vascular trauma, carry a significant risk of morbidity and mortality, with the potential for severe central neurologic deficits and death rates ranging from 10% to 50%. Penetrating trauma to the carotid arteries occurs in up to 20% of all trauma neck cases and when these injuries are not promptly diagnosed and treated, the consequences can be dire. Penetrating carotid injuries are often the result of violence, such as knife wounds or low-velocity firearm injuries, particularly in urban settings. In contrast, in military or combat environments, high-velocity firearm injuries are more common, and these are typically more severe and life-threatening. The urgency in managing carotid injuries lies in the need to quickly restore and maintain cerebral blood flow, prevent stroke, and manage hemorrhage, all while navigating the complex and delicate structures of the neck and concomitant injuries. In this manuscript, we will explore the anatomic considerations, clinical presentation, and evolving strategies for the surgical and endovascular management of penetrating carotid trauma. The focus will be on how modern diagnostic tools and treatment approaches, particularly the shift from traditional zone-based management to a more flexible "no-zone" approach, have improved outcomes for patients with these potentially fatal injuries.