Blunt traumatic carotid artery dissection still a pitfall? The rationale for aggressive screening

The optimal diagnostic strategy for carotid dissection following blunt trauma is yet unclear. The rationale for aggressive screening will be discussed based on a consecutive case series of blunt traumatic carotid artery dissection (CAD). Five patients admitted to our level I trauma center developed severe complications as a consequence of blunt traumatic CAD. The diagnosis of CAD was delayed in all five patients until serious cerebral ischemia occurred. Despite the current awareness that CAD can result from blunt trauma, this type of injury is often overlooked. Clinical and radiological advances have considerably increased the knowledge of incidence and underlying mechanisms of traumatic CAD. This could have implications for case identification and the evaluation of treatment strategies in clinical trials in the future. Screening may increase the rate of early CAD diagnosis, but it is unclear if screening will also result in early detection of a treatable lesion. Trials have to provide the answer to whether initiating therapy will lead to improvements in the outcome in traumatic CAD. We therefore believe that screening is a basic condition for initiation of future clinical trials.