One-hundred twenty-nine patients with carotid artery injuries were analyzed to compare the results of revascularization with those of ligation or occlusion. In patients who present with central neurologic deficit short of coma (Grades 1 to 4), revascularization is clearly the operative method of choice. Revascularization in patients with preoperative coma (Grade 5) is also indicated when ischemia has only been present for a short period of time before surgery. Controlling cerebral edema and minimizing infarct size in patients with severe deficits may be essential to optimize the chance of recovery of these patients.