Blunt Carotid Trauma

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Abstract Summary

In Hong Kong, blunt trauma prevails. Carotid artery is vulnerable to be injured in different common mechanisms like hyperextension in neck whiplash, stretching of the carotid by mandibular or LeFort’s fractures occurred in fall or motorcycle accidents. Blunt carotid artery injuries account for 3 to 10% of all carotid injuries and 1% of blunt trauma cases. It is not common but not rare. It has high neurovascular sequela if left untreated and unnoticed. The natural progression and presentation is bizarre, from asymptomatic initially, vague neurological and vascular soft signs, to stroke within 30 days. Carotid blunt trauma does respond to medical and surgical treatment if it is diagnosed early. In the late 90’s, different trauma centres have been looking into and tried to predict the occurrence of blunt carotid trauma from various signs, symptoms and risk factors of concomitant injuries. If the patients fit the screening criteria, they should have an imaging within 12 hours. Screening modalities are CTA (60%), MRA (22.8%), conventional arteriography (15%) or duplex USG (1.7%). Denver group further grades the disease with the injury morphology, stroke rate, mortality rate, progress and suitable treatment modalities. The goals are to minimise disease progress, decrease ischemic event and improve neurological deficits. In the endovascular era, the inaccessible part of the carotid can be accessed and treated by stenting together with medications like Aspirin or anticoagulant. In KCC, a conjoint screening programme was embarked in 2018 based on the signs, symptoms and the associated neighbouring fractures to look into this under-diagnosed but disabling disease.


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