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September 1988

The Role of Arterial Reconstruction in Penetrating Carotid Injuries

Arch Surg. 1988;123(9):1106-1111. doi:10.1001/archsurg.1988.01400330082013

• The outcome of 80 patients with 85 penetrating injuries to the extracranial carotid artery (CA) were analyzed after three types of treatment: (1) 54 patients, 17 with a neurologic deficit, who underwent arterial reconstruction; (2) 18 patients, eight with a neurologic deficit, who had CA ligation or nonoperative management of a CA occlusion; and (3) eight patients, two with a deficit, who had minimal nonocclusive injuries managed nonoperatively. Outcome was analyzed using a Carotid Neurologic Score (CNS). The CNS is a quantitative measure of neurologic outcome and survival and ranges from − to +3. The higher the CNS, the more favorable the outcome. The conditions of nine patients in group 1 neurologically improved after treatment, 41 were the same, and four were worse. Forty-four patients were neurologically intact and three died. The mean (±SD) CNS was 1.9 ± 0.8. In group 2, one patient's condition improved, 13 stayed the same, and four deteriorated. Ten patients were intact and two died. The mean CNS was 1.3±1.13. In group 3, two patients' conditions improved and six stayed the same. All eight patients were intact; there were no deaths. The mean CNS was 2.3±0.35. There was a significantly higher CNS for groups 1 and 3 compared with group 2. The CNSs of groups 1 and 3 were not significantly different. Arterial reconstruction provides the best outcome for all penetrating CA injuries except nonocclusive limited intimal injuries that require only observation.

(Arch Surg 1988;123:1106-1111.)