This is a retrospective study of 124 patients with carotid injuries. The common carotid artery was injured in 84% of the patients. Associated trauma to the internal jugular vein was present in 26%. Most patients (56%) were dead on arrival to the hospital and of those who were operated on, the mortality was 22% (overall mortality, 66%). All operative mortalities had severe shock or neurologic deficits on admission. We performed repair on all patients with preoperative neurologic deficits and the mortality was 64%. The use of a shunt did not influence the prognosis. We believe that there is no place for an emergency angiogram in order to diagnose a carotid injury or to plan the operation.