Logo of annsurgLink to Publisher's site
Ann Surg. Nov 1978; 188(5): 587–592.
PMCID: PMC1396760

Management of penetrating carotid arterial injury.


A review of the experience with penetrating wounds to the carotid artery was undertaken in an effort to establish concise clinical criteria for surgical management. These results were compared with similar cases from the literature reported since 1963. In these 233 cases, the presence or absence of preoperative neurological deficits was correlated with vascular repair or ligation of the carotid artery. The presence of coma preoperatively was the single most influential factor in determining operative management and prognosis. Patients without a neurological defect should have restoration of vascular continuity (0% mortality, 0.6% morbidity), which produces significantly better results than carotid ligation (p less than 0.002). Patients with all grades of neurological deficit, short of coma, should also have primary vascular repair. Morbidity and mortality rates are significantly less than those following ligation (15 vs. 50%, p less than 0.05). In comatose patients, neither repair nor ligation appear to influence the poor prognosis. At the present time, ligation of the carotid artery is only indicated in the comatose patient who has no evidence of prograde flow or if repair is technically impossible.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (794K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Bradley EL., 3rd Management of penetrating carotid injuries: an alternative approach. J Trauma. 1973 Mar;13(3):248–255. [PubMed]
  • Buchman RJ, Thomas PA, Jr, Park B. Carotid artery injuries. Follow-up of fifteen patients treated in Viet Nam. Angiology. 1972 Feb;23(2):97–102. [PubMed]
  • Cohen CA, Brief D, Mathewson C., Jr Carotid artery injuries. An analysis of eighty-five cases. Am J Surg. 1970 Aug;120(2):210–214. [PubMed]
  • DENNY-BROWN D, MEYER JS. The cerebral collateral circulation. II. Production of cerebral infarction by ischemic anoxia and its reversibility in early stages. Neurology. 1957 Aug;7(8):567–579. [PubMed]
  • Flax RL, Fletcher HS, Joseph WL. Management of penetrating injuries of the neck. Am Surg. 1973 Mar;39(3):148–150. [PubMed]
  • HARDESTY WH, WHITACRE WB, TOOLE JF, RANDALL P, ROYSTER HP. Studies on vertebral artery blood flow in man. Surg Gynecol Obstet. 1963 Jun;116:662–664. [PubMed]
  • Hewitt RL, Smith AD, Becker ML, Lindsey ES, Dowling JB, Drapanas T. Penetrating vascular injuries of the thoracic outlet. Surgery. 1974 Nov;76(5):715–722. [PubMed]
  • MEYER JS, DENNY-BROWN D. The cerebral collateral circulation. I. Factors influencing collateral blood flow. Neurology. 1957 Jul;7(7):447–458. [PubMed]
  • MEYER JS. Importance of ischemic damage to small vessels in experimental cerebral infarction. J Neuropathol Exp Neurol. 1958 Oct;17(4):571–585. [PubMed]
  • Meyer JS, Teraura T, Marx P, Hashi K, Sakamoto K. Brain swelling due to experimental cerebral infarction. Changes in vasomotor capacitance and effects of intravenous glycerol. Brain. 1972;95(4):833–852. [PubMed]
  • Monson DO, Saletta JD, Freeark RJ. Carotid vertebral trauma. J Trauma. 1969 Dec;9(12):987–999. [PubMed]
  • Sengupta D, Harper M, Jennett B. Effect of carotid ligation on cerebral blood flow in baboons. I. Response to altered arterial PCO2. J Neurol Neurosurg Psychiatry. 1973 Oct;36(5):736–741. [PMC free article] [PubMed]
  • Thal ER, Snyder WH, 3rd, Hays RJ, Perry MO. Management of carotid artery injuries. Surgery. 1974 Dec;76(6):955–962. [PubMed]
  • Williams JW, Sherman RT. Penetrating wounds of the neck: surgical management. J Trauma. 1973 May;13(5):435–442. [PubMed]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...