RESULTS FOLLOWING LIGATION OF THE INTERNAL CAROTID ARTERY

It has long been known that ligation of the internal or common carotid artery is followed by (1) a high mortality rate and (2) a high percentage of cerebral complications. Some of the patients in whom cerebral complications develop survive with residual sequelae, such as varying degrees of hemiplegia, aphasia, mental changes and epilepsy. In prelisterian days the surgical mortality rate from carotid ligation approached and frequently surpassed 50 per cent. It has since been learned that the mortality rate is less when wounds are clean and that sepsis was responsible for many deaths through the intravascular spread of an infected thrombus into the cranial chamber. However, precisely the same sequence of events occurs with and without sepsis; the only difference is in the relative frequency. There are two causes of death and disability: (1) cerebral anemia from inadequate collateral circulation through the circle of Willis, the effects of which