A review of the surgical management of penetrating carotid artery injuries in the Trauma Unit at Groote Schuur Hospital, Cape Town, is presented.
Materials and methods: a retrospective analysis of all surgically treated penetrating carotid artery injuries over a 3-year period was performed. The policy is to repair all injuries to the common and internal carotid arteries. Ligation is reserved for patients with prolonged coma; ischaemic infarcts or cerebral oedema on computerised axial tomography of the brain; technically inaccessible high internal carotid artery injuries, and those with occluded arteries with no distal patency detected during surgery or with angiography.
Results: thirty-two patients with penetrating carotid artery injuries were reviewed. Eleven patients underwent emergency exploration. Twenty-one patients had angiography prior to exploration. Injuries in the emergency group were all repaired, with improvement in level of consciousness; also, two patients had preoperative neurological deficits that improved. Three of the 21 patients in the urgent group underwent ligation of the common carotid artery: one comatose patient with a hemiparesis died following ligation; the other two had improvement in their level of consciousness, one of whom showed improvement of his hemiparesis. The remaining injuries to the common and internal carotid arteries were repaired with improvement in level of consciousness and neurological deficit when present.
Conclusion: operative repair offers the best chance of recovery.