Carotid Endarterectomy for Effective Management of Traumatic Extracranial Carotid Artery Dissection following a Penetrating Neck Injury : A Case Report

Abstract

  We report a case of cervical stab injury in a 62-year-old woman with a past history of depression, who was transported to our hospital via ambulance after a suicide attempt using a kitchen knife. On physical examination, she showed mild lethargy and dysphagia, and we observed an open stab wound (8cm in the major axis) that extended to the common carotid artery on the anterior aspect of the left side of her neck ; however, we detected no active hemorrhage or massive hematoma. Magnetic resonance imaging revealed no acute ischemic lesions. Left-sided carotid angiography revealed significant vessel wall irregularity with severe stenosis extending from the distal common carotid to the origin of the internal carotid artery. Several thrombi were detected in both the common and internal carotid arteries. She was diagnosed with traumatic carotid dissection and underwent emergency carotid endarterectomy (CEA) to prevent further ischemic events. Traumatic carotid artery dissection secondary to a penetrating injury is extremely rare. CEA enables direct observation of the injured vessel and surrounding structures and is therefore recommended for repair and reconstruction of carotid artery dissection. Moreover, CEA facilitates complete removal of intraluminal thrombi, as performed in this patient. Open surgery is a useful approach to treat traumatic carotid artery dissection, particularly in patients with open wounds and intraluminal thrombi.