Traumatic carotid artery dissection: a significant incidental finding

Blunt traumatic carotid artery dissection remains controversial in terms of diagnostic screening, reported incidence, and management. Treatment option s include observation, anticoagulation and endovascular stenting, and aggre ssive surgical repair of the carotid artery injury. Blunt traumatic carotid artery dissections were reviewed through a retrospective study of trauma r egistry records. Seven patients were identified from 3342 patients over 3 y ears. Six patients were identified incidentally during magnetic resonance i maging (MRI) cervical spine/brain screening and one patient during angiogra phic evaluation for possible penetrating neck injury without MRI/magnetic r esonance angiography (MRA). A total of 189 patients underwent MRI screening over this 3-year period, demonstrating a relative incidence of 3.7 per cen t, contrasting with the reported incidence of 0.08 to 0.4 per cent for all trauma patients. All seven patients suffered severe head injuries (mean Gla sgow Coma Score = 4.7) requiring mean intensive care unit and hospital stay s of 15.6 and 23.7 days, respectively. None of the patients showed evidence of stroke with CT scanning on presentation. None of the patients demonstra ted clinical focal neurologic signs or symptoms indicating carotid injury o r stroke. Six patients survived their acute trauma and were discharged to r ehabilitation after initiation of observation tone patient) or anticoagulat ion (five patients). All six patients showed neurological improvement witho ut deterioration clinically or radiographically. In conclusion we propose e arly aggressive screening through MRI/MRA of severely injured patients to d etect occult carotid artery dissections. Conservative medical treatment for this occult injury has been effective in this series of patients.