Carotid arterial trauma

Assessment with the Glasgow Coma Scale (GCS) as a guide to surgical management

E. P. Teehan, F. T. Padberg, P. N. Thompson, B. C. Lee, Michael Silva, Z. Jamil, K. G. Swan, R. W. Hobson

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Management of carotid arterial injuries associated with focal neurological deficit or altered state of consciousness (SCON) remains unresolved. Experience with these injuries in one particular hospital was reviewed and the Glasgow Coma Scale (GCS) utilized to assist with clinical stratification of these patients. A literature review was also conducted to better define indications for repair or ligation of carotid injuries. From 1978 to 1990, 34 patients with carotid arterial injuries were reviewed with reference to the GCS, focal deficit, hypotension, anatomic site and mechanism of injury. The literature from 1952 to 1993 was surveyed for carotid artery injuries (1316 patients). Outcome of treatment with or without repair was compared with pre-operative neurologic status. Thirty-four patients with injuries of the common (24) or internal (10) carotid arteries were managed with repair (68%), ligation (24%) or observation (9%). The SCON was normal in 18 patients; 16 patients (88%) underwent repair and all remained normal. All patients with GCS 9-14 regained a normal SCON after surgical repair, while 10 patients with GCS <8 had repair (5), ligation (3), and non-operative management (2); five returned to normal, four died and one remained comatose. However, outcomes correlated poorly with management. Of 1316 patients cited in the surgical literature, patients with no deficit and patients with pre- operative deficits did significantly better after repair as compared with ligation (P < 0.001). In comatose patients, management did not affect outcome. It is concluded that carotid arterial injuries should be repaired in patients with normal neurologic evaluation, focal pre-operative neurologic deficits and in patients with GCS > 9. Comatose patients with GCS < 8 do poorly regardless of management. The GCS provides an objective for stratification of patients with altered SCON who benefit from repair of carotid arterial injuries.

Original languageEnglish (US)
Pages (from-to)196-200
Number of pages5
JournalCardiovascular Surgery
Volume5
Issue number2
DOIs
StatePublished - Apr 1997
Externally publishedYes

Fingerprint

Glasgow Coma Scale
Wounds and Injuries
Consciousness
Ligation
Carotid Artery Injuries
Internal Carotid Artery
Coma
Hypotension
Nervous System
Observation

Keywords

  • Carotid artery trauma
  • Glasgow Coma Scale

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Surgery

Cite this

Carotid arterial trauma : Assessment with the Glasgow Coma Scale (GCS) as a guide to surgical management. / Teehan, E. P.; Padberg, F. T.; Thompson, P. N.; Lee, B. C.; Silva, Michael; Jamil, Z.; Swan, K. G.; Hobson, R. W.

In: Cardiovascular Surgery, Vol. 5, No. 2, 04.1997, p. 196-200.

Research output: Contribution to journalArticle

Teehan, EP, Padberg, FT, Thompson, PN, Lee, BC, Silva, M, Jamil, Z, Swan, KG & Hobson, RW 1997, 'Carotid arterial trauma: Assessment with the Glasgow Coma Scale (GCS) as a guide to surgical management', Cardiovascular Surgery, vol. 5, no. 2, pp. 196-200. https://doi.org/10.1016/S0967-2109(97)82472-6
Teehan, E. P. ; Padberg, F. T. ; Thompson, P. N. ; Lee, B. C. ; Silva, Michael ; Jamil, Z. ; Swan, K. G. ; Hobson, R. W. / Carotid arterial trauma : Assessment with the Glasgow Coma Scale (GCS) as a guide to surgical management. In: Cardiovascular Surgery. 1997 ; Vol. 5, No. 2. pp. 196-200.
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