Volume 49, Issue 3 Fall 2025 JVU 493-152 | Blunt Traumatic Carotid Dissection in a Near Hanging Victim: Comparative Description of Findings Between Doppler Ultrasound, Computerized Tomography Angiography and Intraoperative Angiography-Blunt Traumatic Carotid Dissection

Blunt Traumatic Carotid Dissection

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This 2025 case report in the Journal for Vascular Ultrasound describes a 27-year-old male near-hanging victim (NHV) with a blunt traumatic carotid dissection (BTCD), specifically a circumferential intimal disruption of the distal left common carotid artery (CCA), known as Amussat’s sign. The patient, with psychiatric history including depression and drug abuse, presented hemodynamically stable and neurologically intact but with characteristic circumferential neck ecchymosis.<br /><br />Initial diagnosis was made by computerized tomography angiography (CT-Angio), which identified a circumscribed intimal lesion in the left distal CCA. Complementary Doppler ultrasound (DUS) was then utilized to dynamically assess the lesion, revealing a dissection flap with turbulent flow and a markedly elevated peak systolic velocity (PSV) of 278 cm/s, indicating severe stenosis. The DUS findings provided real-time hemodynamic insight unavailable in static CT images.<br /><br />Due to the severity and dynamic nature indicated by DUS and CT-Angio, an endovascular treatment was performed via percutaneous transfemoral approach under sedation. A dual-mesh carotid stent was deployed successfully, with intraoperative angiography confirming resolution of the dissection and vessel patency. The patient’s postoperative course was uneventful; anticoagulation was transitioned to dual antiplatelet therapy, and he was discharged in stable condition. Six-month follow-up DUS confirmed a patent stent with normal flow and no restenosis, with the patient neurologically asymptomatic.<br /><br />The report highlights the critical importance of high clinical suspicion for carotid injury in blunt neck trauma, especially NHV cases. While CT-Angio remains the standard initial imaging, Doppler ultrasound is emphasized as a valuable, noninvasive adjunct providing dynamic flow information that aids diagnosis, treatment planning, and follow-up. The authors advocate for incorporating DUS in the evaluation and management of BTCD given its sensitivity, specificity, and cost-effectiveness. Early identification and intervention are crucial to prevent severe neurologic complications and improve outcomes.

Keywords

Blunt traumatic carotid dissection

Near-hanging victim

Amussat's sign

Computed tomography angiography

Doppler ultrasound

Carotid stenting

Dual-mesh carotid stent

Peak systolic velocity

Endovascular treatment

Neck trauma