Overview of Endovascular Management of Traumatic Carotid Lesions

T raumatic extracranial carotid lesions can result from blunt, penetrating, or iatrogenic injuries. Blunt cerebrovascular injuries are found in up to 0.1% of all patients hospitalized for trauma in the United States, but the incidence can be as high as 2.7% in patients with an Injury Severity Score > 16.1 Of note, blunt lesions are associated with neurologic morbidity up to 80% and mortality as high as 40%. Penetrating injuries to the carotid artery occur in up to 10% of all cases of penetrating neck trauma2 and are also associated with a high mortality rate (50%).3 Finally, iatrogenic carotid injuries, in most cases, are associated with misplacement of central venous lines with an incidence of 0.1% to 0.8%.4 Management of extracranial carotid lesions varies from medical therapy to endovascular or open repair, depending on the severity of the lesion and the patient’s overall clinical status. Endovascular repair has gained more acceptance given its decreased invasiveness, safety, and effectiveness.