Carotid and vertebral arterial injuries will continue to be a challenge for the trauma surgeon. Trauma to the carotid and vertebral arteries can be from either penetrating or blunt mechanisms. Penetrating injuries to the neck can result in not only arterial trauma but also aerodigestive injuries. Zone 2 of the neck is easily accessible, but carotid and other arterial injuries in zones 1 and 3 may require more challenging methods of exposure. Endovascular techniques may be crucial for control of these vessels in certain situations. Blunt cerebrovascular injuries (BCVIs) must be sought out using screening criteria when the physician has a high degree of suspicion. Antithrombotics and antiplatelet agents, including heparinoids, warfarin, and aspirin, are the cornerstone of treatment in order to prevent a cerebrovascular accident. Endovascular stent placement may be utilized for grade III injuries such as pseudoaneurysm.
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