The role of arterial reconstruction in penetrating carotid injuries.

The outcome of 80 patients with 85 penetrating injuries to the extracranial carotid artery (CA) were analyzed after three types of treatment: (1) 54 patients, 17 with a neurologic deficit, who underwent arterial reconstruction; (2) 18 patients, eight with a neurologic deficit, who had CA ligation or non-operative management of a CA occlusion; and (3) eight patients, two with a deficit, who had minimal nonocclusive injuries managed nonoperatively. Outcome was analyzed using a Carotid Neurologic Score (CNS). The CNS is a quantitative measure of neurologic outcome and survival and ranges from -1 to +3. The higher the CNS, the more favorable the outcome. The conditions of nine patients in group 1 neurologically improved after treatment, 41 were the same, and four were worse. Forty-four patients were neurologically intact and three died. The mean (+/- SD) CNS was 1.9 +/- 0.8. In group 2, one patient's condition improved, 13 stayed the same, and four deteriorated. Ten patients were intact and two died. The mean CNS was 1.3 +/- 1.13. In group 3, two patients' conditions improved and six stayed the same. All eight patients were intact; there were no deaths. The mean CNS was 2.3 +/- 0.35. There was a significantly higher CNS for groups 1 and 3 compared with group 2. The CNSs of groups 1 and 3 were not significantly different. Arterial reconstruction provides the best outcome for all penetrating CA injuries except nonocclusive limited intimal injuries that require only observation.