Interdisciplinary Successful Revascularization of Traumatic Occlusion of the Right Common Carotid Artery

• Published in: Cureus 2024, Vol.16 (3), p.e55395-e55395
• Main Authors: Ilchev, Boris, Chervenkov, Vasil, Valchev, Nikolay, Nakov, Vladimir, Minchev, Tsvetan, Vassilev, Georgi, Tsvetanov, Tsvetomir, Laleva, Lili, Milev, Milko, Spiriev, Toma
• Format: Report
• Language: English
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.55395

Blunt carotid artery injury (BCI) poses a rare yet severe threat following vascular trauma, often leading to significant morbidity and mortality. We present a case of a 33-year-old male who suffered complete thrombotic occlusion of the right common carotid artery (CCA) following a workplace accident. Clinical evaluation revealed profound neurological deficits, prompting multidisciplinary surgical intervention guided by the Denver criteria (Grade I - disruption inside the vessel that results in a narrowing of the lumen by less than 25%; Grade II - dissection or intramural hematoma causing greater than 25% stenosis; Grade III - comprises pseudoaneurysm formation; Grade IV - causes total vessel occlusion; Grade V - describes vessel transection with extravasation). Surgical exploration unveiled extensive arterial damage, necessitating thrombectomy, primary repair, and double-layered patch angioplasty using an autologous saphenous vein. Postoperative recovery was uneventful, with the restoration of pulsatile blood flow confirmed by Doppler ultrasound. Three-month follow-up demonstrated patent arterial reconstruction and improved cerebral perfusion, despite the persistent neurological deficits. Our case underscores the challenges in diagnosing and managing BCI, advocating for a tailored approach based on injury severity and neurological status. While conservative management remains standard, surgical intervention offers a viable option in select cases, particularly those with complete vessel occlusion and neurological compromise. Long-term surveillance is imperative to assess the durability of arterial reconstruction and monitor for recurrent thromboembolic events. Further research is warranted to refine management algorithms and elucidate optimal treatment strategies in this rare but critical vascular pathology.