Antiplatelet Therapy: An Alternative to Heparin for Blunt Carotid Injury

Wahl, Wendy L.; Brandt, Michael T.; Thompson, B. Gregory; Taheri, Paul A.; Greenfield, Lazar J.

doi:10.1097/00005373-200205000-00012

Cited by 80 publications

(91 citation statements)

References 23 publications

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“…Previous study has shown that in even in asymptomatic, untreated patients with BCVI, the rate of neurological complications can be as high as 21.5% 28 . Some authors have recommended the use of antiplatelet agents as an alternative to avoid the hemorrhagic risks associated with systemic heparin 29,30 . Previous studies have documented decreased stroke rate from approximately 30%-50% to 2%-10% using anticoagulation or antiplatelet therapy 4,6,8,17,22,26,31 .…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have documented decreased stroke rate from approximately 30%-50% to 2%-10% using anticoagulation or antiplatelet therapy 4,6,8,17,22,26,31 . Although there have been no randomized trials, retrospective analyses suggest that both therapies are equally efficacious in reducing ischemic events 6,8,17,30,32 . It is often not possible to prescribe therapy for BCVI on a protocol basis, and individualized therapy is necessary depending on extent of concurrent injury.…”

Section: Discussionmentioning

confidence: 99%

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Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Wei

Montanera

Selchen

et al. 2010

Can. j. neurol. sci.

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574In recent years, blunt cerebrovascular injury (BCVI) is gaining attention as an important sequela of nonpenetrating trauma to the neck and skull base. Blunt cerebrovascular injury affects approximately 1% of all blunt trauma admissions, and the reported incidence is as high as 2.7% in centres with aggressive screening protocols [1][2][3][4][5][6][7][8] . The pattern of BCVI consists of vascular transection, dissection, thrombosis, and formation of pseudoaneurysm or arteriovenous fistula (AVF) 9,10 . The majority of these injuries occur during motor vehicle accidents, with variable rates of carotid and vertebral artery involvement reported in the literature [11][12][13] . If untreated, BCVI can be fatal and result in devastating neurological sequelae, with mortality and morbidity rates reported up to 38% and 67% respectively 14 .One of the difficulties in initiating treatment for BCVI is related to the variable symptomatology. While approximately ABSTRACT: Background: Blunt cerebrovascular injury (BCVI) to the carotid and vertebral arteries is a potentially devastating injury in trauma patients. The optimal management for BCVI has not been standardized. At our institution, 64-slice multi-detector computed tomographic angiography (CTA) has been used as the initial screening exam for BCVI in patients who met predefined screening criteria. The purpose of this study is to review the incidence of CTA-diagnosed BCVI in at-risk patients and to evaluate the treatment and clinical outcome of patients with BCVI. Methods: This study included trauma patients with a positive diagnosis of BCVI on CTA during a 41-month study period. The medical records and relevant radiographic findings were retrospectively reviewed. Results: Twenty seven of 222 blunt trauma patients evaluated with CTA had a positive diagnosis of BCVI, with an occurrence rate of 12.2%. Traumatic brain injury (72.2%) and basal skull fractures (55.6%) were the most frequent associated injuries with carotid trauma while 100% of blunt vertebral injuries occurred in the setting of cervical fractures. Fourteen (51.8%) patients received medical therapy; Eleven (40.7%) patients received conservative treatment. Endovascular treatment was attempted in a single case of vertebral arteriovenous fistula. BCVI-related stroke was found in four patients (14.8%), one of whom developed an infarct while on medical treatment. Conclusions: BCVI is found in a significant portion of blunt trauma patients with identifiable risk factors, and screening CTA has high diagnostic yield in detecting these lesions. Medical therapy is the mainstay of treatment at our institution; however, BCVI-related stroke may occur despite treatment. RÉSUMÉ: Diagnostic et résultats du traitement des traumatismes cérébrovasclaires contondants. Contexte :Le traumatisme cérébrovasculaire contondant (TCVC) à la carotide et aux artères vertébrales est une lésion qui peut être dévastatrice chez les patients qui ont subi un traumatisme. Le traitement optimal du TCVC n'a pas été standardisé. Dans notre institutio...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Wei

Montanera

Selchen

et al. 2010

Can. j. neurol. sci.

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“…Currently, CTA remains an unproven diagnostic modality for this injury, with a sensitivity of between 50% to 68%. 2,3,25 In particular, injuries that may be missed by such noninvasive studies are typically grade I and II injuries; however, pseudoaneurysms and occlusions have also been misdiagnosed. 2,3 The risk associated with angiography in our screened trauma population was 0.1%, while the stroke risk for an undiagnosed grade I CAI is 8% and of VAI is 6%.…”

Section: Diagnostic Imaging and Injury Grading Scalementioning

confidence: 99%

Blunt Cerebrovascular Injuries

Cothren¹,

Moore²

2008

Current Therapy of Trauma and Surgical Critical Care

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“…5,7,8,16,19,26 Whereas our earlier reports explored blunt vertebral artery injuries (BVIs), this current report presents our evaluation of Grade 1 and 2 BCIs. Imaging, progression of injury, and outcomes of these lower-grade BCIs were analyzed to abbreviatioNs ASA = acetylsalicylic acid; BCI = blunt carotid artery injury; BCVI = blunt cerebrovascular injury; BVI = blunt vertebral artery injury; CTA = CT angiography; DSA = digital subtraction angiography; MVC = motor vehicle collision.…”

mentioning

confidence: 99%

Clinical and radiographic outcomes following traumatic Grade 1 and 2 carotid artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey

Scott¹,

Sharp²,

Figueroa

et al. 2015

JNS

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T he management of blunt cerebrovascular injuries (BCVIs), including low-grade blunt carotid artery injuries (BCIs), remains controversial; however, antiplatelet agents or anticoagulation continue to be firstline treatments, with endovascular stenting typically reserved for symptomatic or higher-grade injuries. 5,7,8,16,19,26 Whereas our earlier reports explored blunt vertebral artery injuries (BVIs), this current report presents our evaluation of Grade 1 and 2 BCIs. Imaging, progression of injury, and outcomes of these lower-grade BCIs were analyzed to abbreviatioNs ASA = acetylsalicylic acid; BCI = blunt carotid artery injury; BCVI = blunt cerebrovascular injury; BVI = blunt vertebral artery injury; CTA = CT angiography; DSA = digital subtraction angiography; MVC = motor vehicle collision. obJect Proper screening, management, and follow-up of Grade 1 and 2 blunt carotid artery injuries (BCIs) remains controversial. These low-grade BCIs were analyzed to define their natural history and establish a rational management plan based on lesion progression and cerebral infarction. methods A retrospective review of a prospectively maintained database of all blunt traumatic carotid and vertebral artery injuries treated between August 2003 and April 2013 was performed and Grade 1 and 2 BCIs were identified. Grade 1 injuries are defined as a vessel lumen stenosis of less than 25%, and Grade 2 injuries are defined as a stenosis of the vessel lumen between 25% and 50%. Demographic information, radiographic imaging, number of imaging sessions performed per individual, length of radiographic follow-up, radiographic outcome at end of follow-up, treatment(s) provided, and documentation of ischemic stroke or transient ischemic attack were recorded. results One hundred seventeen Grade 1 and 2 BCIs in 100 patients were identified and available for follow-up. The mean follow-up duration was 60 days. Final imaging of Grade 1 and 2 BCIs demonstrated that 64% of cases had resolved, 13% of cases were radiographically stable, and 9% were improved, whereas 14% radiographically worsened. Of the treatments received, 54% of cases were treated with acetylsalicylic acid (ASA), 31% received no treatment, and 15% received various medications and treatments, including endovascular stenting. There was 1 cerebral infarction that was thought to be related to bilateral Grade 2 BCI, which developed soon after hospital admission. coNclusioNs The majority of Grade 1 and 2 BCIs remained stable or improved at final follow-up. Despite a 14% rate of radiographic worsening in the Grade 1 and 2 BCIs cohort, there were no adverse clinical outcomes associated with these radiographic changes. The stroke rate was 1% in this low-grade BCIs cohort, which may be an overestimate. The use of ASA or other antiplatelet or anticoagulant medications in these low-grade BCIs did not appear to correlate with radiographic injury stability, nor with a decreased rate of cerebral infarction. Although these data suggest that these Grade 1 and 2 BCIs may require less intensive r...

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Antiplatelet Therapy: An Alternative to Heparin for Blunt Carotid Injury

Cited by 80 publications

References 23 publications

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Blunt Cerebrovascular Injuries

Clinical and radiographic outcomes following traumatic Grade 1 and 2 carotid artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey

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