Liberalized Screening for Blunt Carotid and Vertebral Artery Injuries Is Justified

Kerwin, Andrew J.; Bynoe, Raymond P.; Murray, Julie; Hudson, Edwin R.; Close, Timothy P.; Gifford, Robert M.; Carson, Kevin; Smith, Lenwood P.; Bell, Richard M.

doi:10.1097/00005373-200108000-00013

Cited by 158 publications

(142 citation statements)

References 21 publications

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“…At our institution, the selection of trauma patients for BCVI screening is based on the injury mechanism, physical signs, and associated injuries according to the Denver Criteria 22,23 . The risk-based screening mechanism has shown a high yield, with BCVI found in 27% to 44% of patients with risk factors 2,6,7,14,15 . The high incidence of BCVI in our study population shows that a risk-based selection mechanism is an effective practice to screen for BCVI in blunt trauma patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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%

“…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 .…”

mentioning

confidence: 99%

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Wei

Montanera

Selchen

et al. 2010

Can. j. neurol. sci.

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“…There is a reported stroke rate of up to 60% for BCVI. 22 Several investigators 23 believe that stroke from BCVI can be prevented by anticoagulation or surgery or endovascular intervention 5,6,14,24 if the vascular injury is detected early. Because of the devastating potential of BCVI, screening programs have been proposed for patients at risk.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8] In the light of the potential devastating consequences of BCVI, much effort has focused on improving detection and treatment during the past decade. 9,10 Initially, neurologic deficits were thought to be inevitable in these patients, but prompt systemic anticoagulation before the onset of stroke has significantly reduced ischemic neurologic events in such patients.…”

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confidence: 99%

Whole-Body CT Trauma Imaging with Adapted and Optimized CT Angiography of the Craniocervical Vessels: Do We Need an Extra Screening Examination?

Langner¹,

Fleck²,

Kirsch³

et al. 2008

AJNR Am J Neuroradiol

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“…Although screening criteria have been refined with time, there is still no generally accepted set of criteria used by all centers. Moreover, there is also no general consensus whether a liberalized screening protocol is justified 6,16 and of how to screen patients at risk. 1 Noninvasive imaging techniques have markedly improved in recent years and now offer clear advantages over established diagnostic procedures (eg, intra-arterial conventional angiography).…”

mentioning

confidence: 99%

Whole body CT trauma imaging with adapted and optimized CT- angiography of the cranio-cervical vessels: do we need an extra screening examination?

Langner¹,

Fleck²,

Kirsch³

et al. 2008

Fortschr Röntgenstr

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Liberalized Screening for Blunt Carotid and Vertebral Artery Injuries Is Justified

Abstract: The liberalized screening criteria used in this study were appropriate to identify patients with BCI/BVI. This study suggests BCI/BVI to be more common than previously believed and justifies that screening should be liberalized.

Cited by 158 publications

References 21 publications

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Whole-Body CT Trauma Imaging with Adapted and Optimized CT Angiography of the Craniocervical Vessels: Do We Need an Extra Screening Examination?

Whole body CT trauma imaging with adapted and optimized CT- angiography of the cranio-cervical vessels: do we need an extra screening examination?

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