Natural History of Blunt Cerebrovascular Injury: Experience Over a 10-year Period at a Level I Trauma Center

Abstract

Background: Blunt cerebrovascular injury (BCVI) is associated with increased stroke and mortality risk. However, the most appropriate follow-up strategy remains uncertain. Purpose:To better understand the natural history of BCVI and help define the most optimal timing and length of follow-up imaging. Materials and Methods:In this retrospective HIPAA-compliant study, data from all patients treated for BCVI at a level I trauma center between April 1, 2005, and June 30, 2015, were reviewed. For patients with at least one follow-up study, time-to-event analysis was performed to assess the trend in injury evolution. Association of injury grade and injury evolution was also assessed. The Fisher exact test and multivariable logistic regression were used to evaluate association of the number of injured vessels, vessel grade, and vessel type (internal carotid artery, vertebral artery) with BCVI-associated stroke.Results: A total of 1204 patients (800 men; mean age ± standard deviation, 45 years ± 22) with 1604 vessel injuries were evaluated. High-grade (grades 3-5) injuries were less likely to resolve (hazard ratio [HR], 0.2; P < .001) than low-grade injuries. High-grade injuries were more likely to progress than low-grade injuries (HR, 3.3; P = .005). Of the injuries that improved or resolved (343 of 419 [81.9%]), 76% (259 of 343) changed within 30 days after the initial injury, and the remaining 24% (84 of 343) changed between 30 and 90 days. Of the injuries that progressed (46 of 419 [11.0%]), 87% (40 of 46) changed within 90 days. Beyond 90 days, no improvement or resolution occurred, and only 1.4% (six of 419) of injuries progressed. Higher injury grade Address correspondence to L.W.

Current Concepts in Imaging Diagnosis and Screening of Blunt Cerebrovascular Injuries

“…Of injuries that may improve or resolve, a prior study reported that 76% of changes occur within 1 month of the initial injury, and 24% occur by 3 months [46]. Beyond 3 months, no additional improvement or resolution generally occurs [46]. Short term follow-up CTA within 3 months may have the highest diagnostic yield in assessing for injury change, which may also determine whether continuation or cessation of antithrombotic treatment is required following discharge [14].…”

“…After this initial period, follow-up studies indicate that healing of the vessel is inversely associated with initial injury grade [45]. However, the majority of BCVIs, up to 84%, may show improvement or complete resolution over time [46]. Of injuries that may improve or resolve, a prior study reported that 76% of changes occur within 1 month of the initial injury, and 24% occur by 3 months [46].…”

“…However, the majority of BCVIs, up to 84%, may show improvement or complete resolution over time [46]. Of injuries that may improve or resolve, a prior study reported that 76% of changes occur within 1 month of the initial injury, and 24% occur by 3 months [46]. Beyond 3 months, no additional improvement or resolution generally occurs [46].…”

Neurointerventional management of cerebrovascular trauma

“…Patients experiencing craniocervical trauma are at risk of devastating injuries, including traumatic cerebrovascular injury and traumatic brain injury 1 2. Traumatic cerebrovascular injury occurs in 3–20% of patients following craniocervical trauma and is a frequent cause of morbidity and mortality 1 3–5. Timely diagnosis and management can prevent devastating neurological complications 5.…”

“…Traumatic cerebrovascular injury occurs in 3–20% of patients following craniocervical trauma and is a frequent cause of morbidity and mortality 1 3–5. Timely diagnosis and management can prevent devastating neurological complications 5. With improvement in techniques, expertise, and evidence for endovascular interventions, neurointerventionalists play an increasingly important role in the treatment of patients with traumatic cerebrovascular injury 6–9.…”