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Introduction
We report the case of a 33-year-old man suffering from a Grad IV blunt traumatic dissection with occlusion of the left common carotid artery (CCA) and severely compromised perfusion in the ipsilateral anterior cerebral circulation due to insufficient collaterals. The anterograde flow in the internal carotid artery was maintained from the external carotid artery with reversed flow and intracranial vessels were intact with no apparent cerebral ischemia signs.

Methods
Due to the focal traumatic lesion of the CCA without intracranial vessel occlusion including patent internal carotid artery, but compromised hemodynamic situation, it was decided to go for emergent open repair of the common carotid artery. CCA was reconstructed successfully by partial resection of the intimal flap, fixation of the intima, thrombectomy and vessel reconstruction using bovine pericardial patch. Ipsilateral blood flow to the brain was maintained during the operation with a temporary arterio-arterial shunt.

Results
The next day no clinical signs of cerebral infarction were found, except forsigns of brachial plexus lesion on the left side, explaining the initial bilateral brachial palsy. MRI showed minor embolic infarcts in the left-sided MCA territory. CT-angiography and duplexsonography demonstrated both a ö patent, not stenosed CCA.

Conclusions
In blunt traumatic dissection of extracranial cervical arteries, surgical repair can be an option in selected cases where hemodynamics are significantly affected and no intracranial large vessel occlusion is present.