Computed Tomographic Angiography Versus Conventional Angiography for the Diagnosis of Blunt Cerebrovascular Injury in Trauma Patients

Goodwin, Robert B.; Beery, Paul R.; Dorbish, Ronald J.; Betz, J Andrew; Hari, Jayesh K.; Opalek, Judy M.; Magee, David J.; Hinze, Scott S.; Scileppi, Robert M.; Franz, Randall W.; Williams, Trina D.; Jenkins, James J.; Suh, Kwang I

doi:10.1097/ta.0b013e3181b83b63

Cited by 58 publications

(50 citation statements)

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“…3,27,28 However DSA, the reference standard for BCVI detection, continues to be recommended despite being invasive, laborintensive, and available only in specialized centers. 3,4,9,25,[29][30][31] Most injuries missed on CTA are grade I injuries with luminal irregularity, but these have been shown to carry a significant risk of stroke. 3 In a meta-analysis comparing the accuracy of CTA against DSA for BCVI, Roberts et al 10 reported a pooled sensitivity of 66% and specificity of 97% for The incremental effectiveness in all iterations was negative (selective DSA has worse outcomes), and the incremental costs were positive (selective DSA is more expensive), suggesting that selective DSA is less cost-effective than selective CTA.…”

Section: Discussionmentioning

confidence: 99%

“…7 Digital subtraction angiography has been considered the reference standard for BCVI detection. 9,10 Increasingly, CT angiography is used in emergency departments to assess patients. 11 There is considerable variation in the reported sensitivity of CTA for BCVI detection in the literature, and its ability to replace DSA has not been validated, to our knowledge.…”

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confidence: 99%

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Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis

Malhotra¹,

Wu²,

Kalra³

et al. 2015

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis

Malhotra¹,

Wu²,

Kalra³

et al. 2015

AJNR Am J Neuroradiol

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“…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 .…”

mentioning

confidence: 99%

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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“…In their study the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CTA were 97.7%, 100%, 100% and 99.3% respectively. In their prospective study of 158 patients Goodwin et al reported a lower sensitivity of 41% but a comparable specificity of 97% when combining both 16 and 64-slice CTA (10). In this study CTA was performed close to the time of injury whereas DSA occurred anywhere from 24-48 h post trauma.…”

Section: Computed Tomography Angiography (Cta)mentioning

confidence: 84%

Blunt vertebral vascular injury in trauma patients: ATLS® recommendations and review of current evidence

et al. 2017

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Blunt cerebrovascular injury (BCVI) encompasses two distinct clinical entities: traumatic carotid artery injury (TCAI) and traumatic vertebral artery injury (TVAI). The latter is the focus of our review. These are potentially devastating injuries which pose a diagnostic challenge in the acute trauma setting. There is still debate regarding the optimal screening criteria, diagnostic imaging modality and treatment methods. In 2012 the American College of Surgeons proposed criteria for investigating patients with suspected TVAI and subsequent treatment methods, caveated with the statement that evidence is limited and still evolving. Here we review the historical evidence and recent literature relating to these recommendations.

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Computed Tomographic Angiography Versus Conventional Angiography for the Diagnosis of Blunt Cerebrovascular Injury in Trauma Patients

Abstract: Neither 16- nor 64-slice CT angiography is as accurate as CA as a screening tool for BCVI.

Cited by 58 publications

References 6 publications

Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis

Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Blunt vertebral vascular injury in trauma patients: ATLS® recommendations and review of current evidence

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