An 18-year-old male sustains a stab wound to zone I of the neck (below the cricoid). He is hemodynamically stable, with no active hemorrhage or expanding hematoma. CT angiography of neck and chest shows a 1 cm non-occlusive intimal irregularity of the left common carotid artery. What is the most appropriate management?
- A Anticoagulation with heparin or antiplatelet therapy and serial imaging ✓
- B Immediate surgical exploration of the neck
- C Urgent endovascular stenting of the carotid artery
- D Observation without any specific vascular treatment
Explanation
Non-occlusive grade II carotid blunt/penetrating injury (intimal irregularity <25% luminal narrowing) in a neurologically intact, hemodynamically stable patient is managed with antiplatelet (aspirin) or anticoagulation (unfractionated heparin) therapy per Eastern Association for Surgery of Trauma (EAST) and Western Trauma Association guidelines. Risk of stroke without treatment is 20–25%. Zone I injuries (below cricoid, approaching the chest) require CTA of neck and chest given proximity to subclavian and aortic vessels. Immediate surgery is not warranted for a stable patient with an imaging-identified non-surgical injury. Stenting is for pseudoaneurysm or flow-limiting injury.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.