The Endovascular Management Approach to Carotid Artery Injuries: Are We Going Down the Yellow Brick Road?

Introduction: The management of carotid artery injuries (CAI) has evolved from non-operative to newly developed endovascular repair techniques. This study aims to describe the outcomes related to endovascular, operative, or conservative management between patients with CAI. Methods: A retrospective study that included adult patients with CAI from January-2012 to November-2020 was performed. Demographics, injury characteristics, and management were reviewed. Primary outcomes were stroke and death. We compared among the different treatment strategies. Results: A total of 79 patients were included [median age:29RIQ:(22-40) years; 92% male], of which 23 had a common carotid artery (CCA) injury, 40 had an internal carotid artery (ICA) injury, and 16 had an external carotid artery (ECA) injury. The main mechanism of injury was penetrating in 83% (64). The median ISS was 18[RIQ:(13-26)]. 38 (48%) patients were treated non-operatively and 41 (51%) patients were managed operatively [Open Approach (OA):16 (40%); Endovascular Approach (EA):25 (60%)]. Seven patients were managed by open ligation of the injured vessel and 11 by endovascular embolization. The highest percentage of strokes/deaths was seen in the patients with ICA injuries managed non-operatively followed by those managed via ligation and/or embolization. The overall mortality rate was 19% (3/16) in the OA group vs 4% (1/25) in the EA group. Conclusion: Typical non-operative approach to CAI entails a high morbi-mortality especially when the ICA is involved. The ligation/embolization of the ICA carries a potential high risk of stroke and/or death. Our results show that endovascular surgical repair techniques used to treat significant CAI are leading us down the appropriate “yellow brick road”.