Ces radiol. 2023, 77(1):41-48 | DOI: 10.55095/CesRadiol2023/007

Blunt injury of the cervical segment of the internal carotid artery

Miroslav Šercl^1,5, Jakub Lípa¹, Tomáš Beran^1,3, Zuzana Eichlová², Jan Raupach^{4, 5}

¹ Radiodiagnostické oddělení Centra zobrazovacích metod, Krajská nemocnice Liberec, a. s.

² Neurologické oddělení Neurocentra, Krajská nemocnice Liberec, a. s

³ Ústav klinických oborů a biomedicíny Fakulty zdravotnických studií, Technická univerzita v Liberci

⁴ Radiologická klinika LF UK a FN, Hradec Králové

⁵ Lékařská fakulta UK, Hradec Králové

Aims: The main aim of this study is to analyze the effectiveness and causalrelationships of treatment of patients with blunt injury of the cervicalsegment of internal carotid artery (ICA) in a prospective observational study.

Methods: A retrospective analysis with prospective data collection was used toevaluate a cohort of patients diagnosed with extracranial ICA injuries betweenthe years 2010 and 2020. In all patients, we followed up the initial clinicalsymptomatology, findings on initial CT angiography (CTA), chosen therapy,follow-up brain imaging, and assessment of neurological status with carotidimaging after 3 months.
Sixteen patients with blunt ICA injury diagnosed in triage-positive patientsexamined by whole-body CT scan for suspected polytrauma were included.Patients with severe bleeding lesions were left without antithrombotic therapyuntil the hemorrhagic injuries were repaired, after which they were treatedwith a combination of antiplatelet therapy with acetylsalicylic acid (ASA) +low molecular weight heparin (LMWH) at a prophylactic dose. Patients withbrain injury (contusions or intracranial haemorrhage) were treated withLMWHonly at prophylactic dose from the second or third day after trauma.Patients who developed neurological symptomatology related to ICA injury weremanaged on a strictly individual basis with consideration of all potentialrisks associated with aggressive antithrombotic therapy. All patients with ICAlumen stenosis underwent follow-up CTA in 2-3 days to rule out severe progression of the lesion. In addition, patientswere followed up after 3 months with ultrasound or CTA. In the evaluation ofthe cohort, we focused on the incidence of neurological complications inrelation to the severity of the stenotic ICA lesion.

Results: Of the 4145 patients examined on CT after high-energy trauma, 16(0.4%) patients with blunt ICA injury were recorded. In 4 cases, the ICAfindings were bilateral, thus the total number of carotid injuries was 20.Four times (20%) the artery was closed, 7 times (35%) with stenosis greaterthan 80%, and 9 times (45%) with stenosis less than 80%. All patients weretreated conservatively. Three patients (19%) were treated with LMWH at aprophylactic dose from the second day after trauma due to the findings oftraumatic SAH and cerebral contusions. In 7 (44%) patients, treatment with ASA+ LMWH in prophylactic dose was set after the treatment of hemorrhagicinjuries. In 6 (38%) mobilized patients without associated major trauma, onlyantiplatelet therapy was deployed. We did not observe any stroke symptoms in 5patients with ICA stenosis up to 80%. In 6 patients with ICA stenosis above80%, we observed once neurological symptomatology, and in 4 patients with ICAocclusion, we observed permanent neurological disability in 2 cases. Thus, werecorded a total of 3 (19%) neurological complications related to blunt ICAinjury, of which one (6 %) was severely disabling.

Conclusion: Patients with blunt injury of ICA after high-energy trauma withstenosis findings up to 80% can be successfully treated conservatively. Inpatients with ICA oclusion, neurological disability can be expected in 50 % ofcases. The treatment of symptomatic patients with associated injuries shouldbe strictly individualized with consideration of all potential risks ofpharmacological or endovascular treatment.

Keywords: blunt cerebrovascular injury, CT angiography, neurologicalsymptomatology, risk of stroke, trauma

Published: March 1, 2023  Show citation