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Wed Jul 4 15:11:49 BST 2007

Agreed totally.
I would add one more caveat:

11. Once again, managing these injuries as for non-trauma diseases is wrong
and potentially dangerous.

For those advocating stenting of carotids, where stenting in carotid
stenosis is controversial, I believe at the moment it is contra-indicated,
given the reported >60% short to mid-term occlusion rates seen with
traumatic carotid injury.

Karim

On 04/07/07, KMATTOX at aol.com <KMATTOX at aol.com> wrote:
>
> For more than 20 years, I have been following, contributing to, and trying
> to decipher the ongoing literature and descriptive research regarding
> blunt
> carotid artery injury.   Several points can be made:
>
> 1.    This diagnosis DOES exist
> 2.    Blunt carotid artery injury does produce both  death and paralysis
> 3.    Blunt carotid artery injury is as common as one  attempts to study
> it
> 4.    Undoubtedly, in many cities, the incidence goes  undetected because
> it
> is not diagnosed or looked for
> 5.    Carotid arteriography is more accurate in  diagnosing this condition
> than CTA
> 6.    Doppler studies and vascular ultrasound are of  little help in
> making
> the diagnosis of internal carotid artery injury
>
> 7.    The term "dissection" of the internal carotid  artery is very poorly
> communicated among specialists as NO ONE,  NO ONE has  described
> pathologically
> just what is meant by this radiographic  term.   Is it a subintimal area
> of
> blood and dye?   Is it a  tear in the media?  Is it dye in the
> periadvential
> space?    Pathologically ,just what is happening.   NO ONE HAS looked at
> these
> lesions under the microscope.    Therefore our treatments cannot  be
> specifically directed.
>
> 8.    The classification schemas are still confusing  and weak
> 9.    The treatment recommendations of heparin, no  heparin, stent/no
> stent,
> operation/no operation are based on very flimsy  observations and are not
> standardized.
>
> 10.    I could take either side of a debate on the  diagnosis and
> treatment
> of this disease and would be comfortable in knowing it  would be a fun
> debate,
> but no one would have enough data to support a  win.
>
> k
>
>
>
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