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 language | English (US) |
|---|---|
| Pages (from-to) | 196-200 |
| Number of pages | 5 |
| Journal | Cardiovascular Surgery |
| Volume | 5 |
| Issue number | 2 |
| DOIs | |
| State | Published - Apr 1997 |
| Externally published | Yes |
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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 journal › Article
}
TY - JOUR
T1 - Carotid arterial trauma
T2 - Assessment with the Glasgow Coma Scale (GCS) as a guide to surgical management
AU - Teehan, E. P.
AU - Padberg, F. T.
AU - Thompson, P. N.
AU - Lee, B. C.
AU - Silva, Michael
AU - Jamil, Z.
AU - Swan, K. G.
AU - Hobson, R. W.
PY - 1997/4
Y1 - 1997/4
N2 - 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.
AB - 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.
KW - Carotid artery trauma
KW - Glasgow Coma Scale
UR - http://www.scopus.com/inward/record.url?scp=0030991232&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0030991232&partnerID=8YFLogxK
U2 - 10.1016/S0967-2109(97)82472-6
DO - 10.1016/S0967-2109(97)82472-6
M3 - Article
VL - 5
SP - 196
EP - 200
JO - Vascular
JF - Vascular
SN - 1708-5381
IS - 2
ER -