Role of open surgery in meeting the challenges of blunt carotid trauma

A 51-year-old gentleman presented to the Emergency Department with an altered level of consciousness following blunt trauma to the right neck whilst working on a construction site. Primary and secondary trauma assessment revealed that the patient had stable haemodynamics with evidence of evolving right hemispheric ischaemia. The patient became increasingly drowsy and agitated, subsequently developing left sided neurology. Following multiple episodes of vomiting and a deterioration in the level of consciousness, the patient was intubated. Computed tomography (CT) carotid angiogram (Fig. 1) revealed occlusion of the right common carotid artery (CCA) 2 cm distal to its origin. Impaired flow into the right internal carotid artery (ICA) was noted, with minimal ï¬lling at the carotid bifurcation (CB) and absent contrast within the extracranial right ICA. The Circle of Willis (COW) was incomplete with an absent anterior communicating artery. CT brain revealed no evidence of acute intracranial haemorrhage or infarct.