INTERNAL CAROTID-ARTERY GUNSHOT WOUNDS

Objective: To review a series of patients who sustained internal carot id artery (ICA) gunshot wounds, Design, Materials, and Methods: We ret rospectively studied the demographics and clinical presentation, angio graphic findings, methods of treatment, and outcome of 38 consecutive patients who had ICA injury identified by angiography, Results: Thirty -four of 38 patients were symptomatic with neck hematomas (32 patients ), active hemorrhage (12 patients), and/or neurologic deficit (10 pati ents), Angiography showed active bleeding in 22 patients and occlusion in 16 patients, Twelve patients were treated operatively by ligation (seven patients), repair (four patients), or intracranial/extracranial bypass (one patient), Twenty-six patients were managed nonoperatively either by angioplasty (one patient), embolotherapy (17 patients), or observation alone (eight patients), Percutaneous balloon catheters wer e also used in three patients for vascular control of the ICA before o perative repair or as a method of assessing intracranial collateral ci rculation, The mortality of 18.4% was largely related to strokes,Concl usions: Penetration of the ICA is a very severe injury with a high mor tality, The major cause of death in this series was related to neurolo gic damage associated with carotid injury and shock, However, neurolog ic deficit among the survivors was uncommon and often resulted from em boli. Interventional radiology can play an important role in the manag ement of these wounds and often obviates the need for operative explor ation.