Primary Repair vs Ligation for Carotid Artery Injuries

The morbidity and mortality of carotid arterial injuries in 36 patients were retrospectively reviewed. Primary repair was achieved in 31 patients; nine patients had a stroke postoperatively and five died. Five patients were treated with ligation; three had a stroke postoperatively, but all survived. Postoperative stroke and mortality correlated best with neurological deficit on admission. Patients in shock or with absent arterial flow were also more likely to have postoperative stroke. Twenty-two patients were normal neurologically on admission; all were normal postoperatively and all survived. Five patients were admitted unconscious in severe shock, precluding accurate neurological evaluation; two were normal following repair and three had stroke. Nine patients had a stroke or coma on admission; all nine had postoperative stroke and five died. Autopsy disclosed bilateral cerebral edema in two patients, cerebral edema and ipsilateral ischemic infarction in two patients, and cerebral edema with bilateral necrosis in one patient. No patient had hemorrhagic infarction. On the basis of these findings, carotid artery repair is recommended in all patients who are not comatose, have stable vital signs, and have technically reparable injuries.