Blunt Cerebrovascular Injuries

Cothren, Clay C.; Moore, Ernest E.

doi:10.1016/b978-0-323-04418-9.50035-7

Cited by 5 publications

(9 citation statements)

References 40 publications

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“…These mechanisms explain why up to 44% of patients with initially clinically inapparent VAI become clinically symptomatic during the next 18 h. The good long-term outcome of our VAI patients in this series may be due to early diagnosis followed by the aggressive treatment protocol with early surgery and consequent anticoagulation used in this study. The anticoagulative treatment in our study is not evidence based, but it is concordant with previously published anticoagulative protocols for VAI [7,13].…”

Section: Treatmentsupporting

confidence: 89%

Vertebral artery injuries following cervical spine trauma: a prospective observational study

et al. 2011

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Section: Treatmentsupporting

confidence: 89%

Vertebral artery injuries following cervical spine trauma: a prospective observational study

et al. 2011

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“…The reported incidence is highly variable in the literature (0.5-2% of all trauma patients) [3][4][5][6][7]. Some series have found coexisting TVAI in up to 20% of patients with head injuries.…”

Section: Epidemiologymentioning

confidence: 77%

“…This algorithm used CTA for diagnosis and recommended anticoagulation for all but grade 5 (transection) injuries using the Denver Blunt Carotid and Vertebral Artery Grading Scale and the Denver Screening Criteria for blunt cerebrovascular injury [4]. However, the major limitation of this work is the inclusion in both sets of Denver criteria of carotid and vertebral injuries as a single entity.…”

Section: Screening For and Diagnosing Tvaimentioning

confidence: 99%

“…Complications and adverse events of endovascular intervention in TVAI are anecdotal. The Denver studies provide data on complications of carotid artery stenting after TCAI [4,32], but this cannot be extrapolated to TVAI, which should be examined as a separate entity as the mechanism, symptoms and ease of surgical and radiological access to the carotid and vertebral arteries differ [19]. Currently, the only long-term follow-up of endovascular treatment is with regard to carotid artery injuries [48].…”

Section: Conventional Treatment Of Tvaimentioning

confidence: 99%

“…Examination findings of posterior circulation ischaemia include dysarthria, impaired balance and coordination, ataxic gait, visual field defects, diplopia, nystagmus, Horner's syndrome, hiccups, lateral or medial medullary syndrome, lower cranial nerve palsies, papillary abnormalities and impaired consciousness. Physical examination findings suggestive of associated trauma based upon the mechanisms suggested by the Denver criteria are neck tenderness, maxillofacial injuries, skull base fracture, head trauma, signs of hanging, high impact, flexion/extension or deceleration injury [4].…”

Section: Physical Examinationmentioning

confidence: 99%

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Blunt traumatic vertebral artery injury: a clinical review

et al. 2011

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Blunt traumatic vertebral injury (TVAI) is frequently associated with head and neck injury and is being detected with increasing frequency due to improved imaging of the trauma patient. In a few cases, it can lead to potentially fatal posterior circulation ischaemia There is debate in the literature regarding whether TVAI should be actively screened for and, if so, how. Management of TVAI may be conservative, medical (antiplatelet agents or anticoagulation), endovascular or open surgery. We review the literature concerning the mechanisms and presentation of TVAI following blunt injury and the current screening recommendations. Management strategies proposed are based on the radiological grade and clinical severity of TVAI, where high-grade symptomatic injuries and highgrade injuries in patients where anticoagulation is contraindicated are treated endovascularly and asymptomatic or low-grade injuries are managed with anticoagulation where it is not contraindicated. Follow-up is via CT angiography to assess for resolution of the injury.

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Antithrombotic choice in blunt cerebrovascular injuries: Experience at a tertiary trauma center, systematic review, and meta-analysis

Priola

Mathieu

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Blunt cerebrovascular injuries (BCVIs) may occur following trauma and lead to ischemic stroke if untreated. Antithrombotic therapy decreases this risk; however, the optimal agent has yet to be determined in this population. The aim of this study was to compare the risk-benefit profile of antiplatelet (AP) versus anticoagulant (AC) therapy in rates of ischemic stroke and hemorrhagic complications in BCVI patients. METHODS:We performed a retrospective review of BCVI patients at our tertiary care Trauma hospital from 2010 to 2015, and a systematic review and meta-analysis of the literature. The OVID Medline, Embase, Web of Science, and Cochrane Library databases were searched from inception to September 16, 2019. References of included publications were searched manually for other relevant articles. The search was limited to articles in humans, in patients 18 years or older, and in English. Studies that reported treatment-stratified clinical outcomes following AP or AC treatment in BCVI patients were included. Exclusion criteria included case reports, case series with n < 5, review articles, conference abstracts, animal studies, and non-peer-reviewed publications. Data were extracted from each study independently by two reviewers, including study design, country of origin, sex and age of patients, Injury Severity Score, Biffl grade, type of treatment, ischemic stroke rate, and hemorrhage rate. Pooled estimates using odds ratio (OR) were combined using a random-effects model using a Mantel-Hanzel weighting. The main outcome of interest was rate of ischemic stroke due to BCVI, and the secondary outcome was hemorrhage rate based on AC or AP treatment. RESULTS:In total, there were 2044 BCVI patients, as reported in the 22 studies in combination with our institutional data. The stroke rate was not significantly different between the two treatment groups (OR, 1.27; 95% confidence interval, 0.40-3.99); however, the hemorrhage rate was decreased in AP versus AC treated groups (OR, 0.38; 95% confidence interval, 0.15-1.00). CONCLUSION:Based on this meta-analysis, both AC and AP seem similarly effective in preventing ischemic stroke, but AP is better tolerated in the trauma population. This suggests that AP therapy may be preferred, but this should be further assessed with prospective randomized trials.

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Blunt Cerebrovascular Injuries

Cited by 5 publications

References 40 publications

Vertebral artery injuries following cervical spine trauma: a prospective observational study

Vertebral artery injuries following cervical spine trauma: a prospective observational study

Blunt traumatic vertebral artery injury: a clinical review

Antithrombotic choice in blunt cerebrovascular injuries: Experience at a tertiary trauma center, systematic review, and meta-analysis

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