• M Reuber, L A Dunkley, E P L Turton, M D D Bell, and J M Bamford.
• Leeds Teaching Hospitals NHS Trust, General Infirmary at Leeds, Great George Street, Leeds, LS2 9NS, UK. mreuber@doctors.org.uk
• Acta Neurol. Scand. 2002 Mar 1;105(3):235-9.

ObjectiveTo alert clinicians to the stroke risk associated with carotid artery injury secondary to attempted internal jugular venous (IJV) cannulation.MethodsCase reports and review of the literature.ResultsFour patients developed a stroke following carotid artery (CA) injury during attempted IJV cannulation using the landmark technique. In all cases the arterial puncture was detected immediately and firm pressure applied for several minutes. In three cases there was evidence of intimal injury and thrombus formation. Two strokes were delayed by more than 24 h. One patient died. A review of studies describing 4487 IJV line insertion attempts using the landmark technique reveals that 5.9% of attempts are associated with CA injury.ConclusionCannulation of the IJV using visible and palpable landmarks is associated with a risk of stroke. Arterial injury and stroke should be mentioned when consent is obtained for cannulation. Consideration should be given to a reduction of the arterial injury risk by using ultrasound guidance during line insertion.

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