Traumatic intimal prolapse of the common carotid artery

Traumatic dissection of the common carotid artery after blunt injury to the neck

BACKGROUND

Occlusive lesions of the common carotid artery (CCA) resulting from blunt injury are extremely rare, and their clinicopathologic and therapeutic features have not yet been clarified.

OBJECTIVES AND RESULTS

Five patients with occlusive lesions of the CCA developed neurologic deficits at 1.5 hours to 10 years after blunt neck injury. Lesions included two complete occlusions, one severe stenosis, and two segmental intimal dissections of the CCA. In the two patients with CCA occlusion, bypass surgery was performed using a Dacron graft between the ipsilateral subclavian artery and the carotid bifurcation. In the remaining three patients, the involved segments were replaced with a Dacron graft. Surgical specimens from the early posttraumatic period revealed intimal tears with mural thrombosis and/or subintimal hematomas and those from the later period showed myointimal hyperplasia or fibrotic organization.

CONCLUSION

Traumatic occlusive lesions of the CCA tend to evolve from intimal dissections to severe stenoses or occlusion, compromising cerebral circulation. The involved CCA can be diagnosed early by B-mode Doppler sonography and successfully reconstructed using a Dacron graft.

Traumatic carotid artery dissection

Traumatic carotid artery dissection is rarely seen as a cause of death in the forensic setting. Three cases of traumatic carotid artery dissection that demonstrate many of the typical features are presented. There is usually a history of some violent trauma to the head or neck, motor vehicle accidents being the commonest cause. The carotid artery may be injured anywhere from the common carotid portion to the cavernous sinus, resulting in infarction of the corresponding cerebral hemisphere. Clinically, symptoms may include loss of consciousness, hemiparesis, aphasia, and Horner's syndrome, these typically occurring after an interval of hours to days. Carotid artery injury may not be associated with evidence of external injury and initially may go undetected or may be misinterpreted in the setting of associated neck or head trauma. The commonest mechanisms are thought to be blunt neck trauma and neck hyperextension. The cases presented highlight the importance of early diagnosis if surgery is to be possible to avoid a fatal outcome.

Blunt trauma to the carotid artery with transient deficit and early repair

Blunt trauma to the carotid artery is an uncommon but easily overlooked source of neurological deficit. The prompt diagnosis and angiographic definition of carotid-artery injuries can allow early operative intervention in these potentially devastating lesions. We describe a case report of blunt trauma with transient deficit in a patient who underwent direct repair via Dacron-patch angioplasty.

Blunt carotid artery trauma: report of two cases and review of the literature

Blunt carotid artery trauma is uncommon but has been associated with severe, permanent neurologic deficits in 42% and mortality in 30% of 96 patients previously reported in the English literature. Since neurologic symptoms characteristically develop only after a latent interval and since physical evidence of significant cervical trauma often is absent, diagnosis of nonpenetrating carotid injuries with the use of arteriography usually is delayed until the appearance of obvious, frequently irreversible neurologic complications. Carotid injuries should be suspected in patients who develop monoplegia or hemiplegia following blunt craniocervical trauma, particularly if computerized tomography excludes the presence of intracranial hemorrhage. The cumulative results of a collected series of 96 patients suggest that early surgical correction of blunt carotid injuries is appropriate for patients with transient episodes of cerebral ischemia, strokes in evolution, or mild completed neurologic deficits.

[Haemorrhage and haemostasis in face, visceral cranium, neck and middle ear region (author's transl)]

Head and neck surgery is accompanied by more or less heavy tendency to bleed. Spontaneous bleeding will occur, because of general and local peculiarities depending on the vascularisation of this region. The general part of the paper deals with normal haemostasis and the diagnosis of haemorrhagic diathesis. This part also shows simple surgical measures in order to stop bleeding. The special section of the paper explains bleeding problems by case history. Here mainly complications are shown exceedingly imporant to the ENT Doctor, because of their more common frequency i.e. nose-bleeding, adenotonsillextomy as well as alarming haemorrhage from great vessels of the neck (arrosion bleeding of the carotid artery, lesion due to accidents and following necksurgery).