Dissecting trauma of the extracranial carotid artery: Elective surgical treatment of a stabilized case

This study describes a case of stabilized dissecting trauma of the common carotid artery and related surgical treatment. A 46-year-old man was admitted because of blunt neck injury, with crushing of the vessel and symptoms of dysarthria. Magnetic resonance imaging showed dissection of the left common carotid artery at the bifurcation and a hypodense cerebral area in the left temporoparietal region. Echo Doppler ultrasonography confirmed dissection of the intima; flowmeter study showed hemodynamically significant stenosis. The clinico-neurologic picture was stable; surgical repair of the carotid artery was performed. On surgery, the vessel appeared dilated at the level of the bulb, whereas the remaining portion of the common, internal and external carotid was normal. On opening of the bifurcation, dissection with endothelialization of the intimal flap were observed. A PFTA graft (6 mm) was fashioned in a 5-cm segment between the common carotid and the bifurcation. Intraoperative angiographic control showed good morphology. Histology showed thickening of the intima, with neointimal hyperplasia and diffuse fibrotic areas, whereas the media was affected by lymphomonoplasmocytary infiltration. The postoperative course was uneventful and the patient was discharged on the 7th day with antiplatelet therapy. On postoperative follow-up at 12 months, echo Doppler sonography showed the graft to be patent, with no internal morphologic or flowmeter changes. Blunt injuries to the extracranial carotid artery can lead to vessel wall damage, with acute and/or progressive neurologic events that require emergency repair. If the neurologic picture is stabile, and the carotid lesion does not tend to rapid progression, elective repair surgery is indicated instead. Repair is essential when the lesion determines significant hemodynamic alterations.