Carotid arterial trauma: assessment with the Glasgow Coma Scale (GCS) as a guide to surgical management1
Section snippets
Patients and methods
For the period from 1978 to 1990, clinical records of 34 consecutive patients with penetrating injuries to the common and internal carotid arteries were reviewed. Hospital records were reviewed retrospectively for the following information: mechanism and anatomical distribution of injuries, haemodynamic stability, neurologic status, associated injuries, surgical management, Morbidity, and mortality associated with the carotid arterial injury.
Immediately following resuscitation, patients were
Results
Penetrating injuries of the common or internal carotid arteries were observed in 34 patients. Thirty patients were male (88%) and four were female; the mean age was 29 years. The distribution of injuries was 19 right and 15 left. The common carotid artery (CCA) was injured in 24 cases and the internal carotid artery (ICA) in 10. A majority of these injuries were from gunshot wounds (23), followed by stab wounds (8) and shotgun wounds (3). Compared to our previous reports[8], the proportion of
Review of the literature
The English language literature from 1952 to 1993 was surveyed for papers concerned with vascular trauma, penetrating wounds of the neck or carotid injuries. An earlier series[1]summarized the literature from 1952 to 1979. Articles from 1980 to 19939, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22were accepted for inclusion, provided information on patients' demographic data, neurologic status and hospital course were included. Those cases associated with head injury or other significant
Discussion
Management of carotid arterial injuries remains complex and continues to generate controversy. Reduction in cerebral blood flow frequently leads to major neurologic morbidity and/or death, with several recent series reporting mortality rates of 10–22%8, 9, 10, 11, 12, 23. Shock, location of arterial injury and ischaemic time have been implicated as adverse influences on neurologic outcome2, 10, 24, 25. Several prior reviews have attempted to correlate the incidence of shock with stroke.
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Presented at the Seventh Annual Meeting of the Eastern Vascular Society, held at the Sheraton Society Hill Hotel, Philadelphia, PA, USA on 30 April 1993