From December, 1975, to December, 1979, 54 carotid artery injuries have been treated by the Southwestern Medical School Department of Surgery. Seventy-eight percent were due to gunshot wounds, 20% were due to stab wounds, and 2% were secondary to blunt trauma. Thirty-three percent involved the internal carotid artery, and the external carotid artery was involved in 20%. Eighteen percent of the patients presented with a major associated venous injury and 8% with an arteriovenous fistula. Partial or complete disruption accounted for the majority of injuries. There was a 10% mortality rate. Four percent of the deaths were due directly to carotid vascular trauma. Because of our experience we believe, whenever possible, all patients should have the benefit of preoperative arteriography. This allows for a well planned operation and avoids major unnecessary neck dissection. High lesions involving the internal carotid artery may be exposed easily by anterior dislocation of the jaw, thus allowing ready access to the base of the skull. Injuries involving extensive areas of the internal carotid artery (lesions extending intracranially) are best managed by extracranial-intracranial (EC-IC) bypass with internal carotid artery ligation. Severe neurologic deficit is best treated by ligation of the carotid artery. Seven patients have undergone EC-IC bypass and 86% of these returned to or maintained normal neurologic status, while the other 14% remained neurologically stable. It is our impression that the risk of neurologic deficit is lessened by this maneuver without added mortality or morbidity.