The Spectrum of Blunt Injury to the Carotid Artery

Cogbill, Thomas H.; Moore, E. E.; Meissner, Mark H.; Fischer, Ronald P.; Hoyt, David B.; Morris, Jonathan; Shackford, Steven R.; Wallace, Joseph; Ross, Steven E.; Ochsner, M. Gage

doi:10.1097/00005373-199409000-00024

Cited by 317 publications

(180 citation statements)

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“…Heparin was initially the treatment of choice for BCVI, with the assumption that this promoted clot stabilization if present and clot resolution through intrinsic fibrinolytic mechanisms, and it prevented further thrombosis. 5,7,8 Treatment with anticoagulant agents has been shown to improve neurologic outcome in patients sustaining BCVI-related ischemic neurologic events (INE). 5,[7][8][9] Initial reports, including one of a multicenter study by the Western Trauma Association, showed that patients who were treated with anticoagulant agents had improved outcome compared to those who were either not treated or had a contraindication for anticoagulation due to associated head injuries.…”

Section: Historical Perspectivementioning

confidence: 99%

“…5,7,8 Treatment with anticoagulant agents has been shown to improve neurologic outcome in patients sustaining BCVI-related ischemic neurologic events (INE). 5,[7][8][9] Initial reports, including one of a multicenter study by the Western Trauma Association, showed that patients who were treated with anticoagulant agents had improved outcome compared to those who were either not treated or had a contraindication for anticoagulation due to associated head injuries. 5,7 In these studies, up to 45% of patients achieved good neurologic status.…”

Section: Historical Perspectivementioning

confidence: 99%

“…5,[7][8][9] Initial reports, including one of a multicenter study by the Western Trauma Association, showed that patients who were treated with anticoagulant agents had improved outcome compared to those who were either not treated or had a contraindication for anticoagulation due to associated head injuries. 5,7 In these studies, up to 45% of patients achieved good neurologic status. The first single-institution study with a large volume of experience demonstrated heparin therapy was independently associated with survival and improvement in neurologic outcomes.…”

Section: Historical Perspectivementioning

confidence: 99%

“…Initially, BCVI were thought to have unavoidable, devastating neurologic outcomes, but several reports have suggested that anticoagulant therapy improves neurologic outcome in patients suffering ischemic neurologic events. [1][2][3][4][5][6][7] If untreated, carotid artery injuries (CAI) have a stroke rate up of to 50% depending on the injury grade, with increasing stroke rates correlated with increasing grades of injury; vertebral artery injuries (VAI) have a stroke rate of 25%. 3 Because many of the patients with BCVI have concomitant traumatic brain injuries, poor outcomes due to neurologic sequelae to BCVI have been attributed to the traumatic brain injury.…”

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confidence: 99%

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Blunt Cerebrovascular Injuries

Cothren¹,

Moore²

2008

Current Therapy of Trauma and Surgical Critical Care

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Section: Historical Perspectivementioning

confidence: 99%

Section: Historical Perspectivementioning

confidence: 99%

Section: Historical Perspectivementioning

confidence: 99%

mentioning

confidence: 99%

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Blunt Cerebrovascular Injuries

Cothren¹,

Moore²

2008

Current Therapy of Trauma and Surgical Critical Care

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“…Several studies have shown that duplex sonography is also not useful for screening BCVI because of insufficient sensitivity between 38.5% [22] and 86% [11]. Another problem for the diagnosis of the BCVI using the duplex sonography is the localisation of the lesion which is often at the base of the skull or at the intraosseous course of the vertebral artery [9,17,21].…”

Section: C1 Fracturementioning

confidence: 99%

Blunt cerebrovascular injuries in acute trauma care: a screening protocol

et al. 2011

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Introduction Blunt cerebrovascular injuries (BCVI) of the extra-or intracerebral vessels are frequently observed lesions which may lead to thrombembolic events with focal neurological deficits, stroke or death particularly in patients \60 years. However, a comprehensive standardised clinical algorithm for screening and management of these secondary injuries is still lacking. Materials and methods We developed a standardised screening protocol applicable for mild as well as severely injured patients. In this prospective cohort study, we evaluated the feasibility of this diagnostic algorithm in a level 1 trauma centre setting. Trauma patients who met the inclusion criteria underwent a computed tomographic angiography (CTA) as part of standard diagnostic procedure at admission. All suspicions or positive findings were reevaluated by a conventional four-vessel catheter angiography within the first 72 h after trauma. Within this period, anticoagulation with low-dose heparin was started. BCVI confirmation indicated a shift to systemic heparinisation with overlapping phenprocoumon therapy for at least 6 months. All patients were reevaluated after 6 months by another four-vessel angiography. Depending on the diagnostic findings, oral anticoagulation may be discontinued or continued for another 6 months.Results A total of 44 patients (8 male, 6 female, age range 19-95 years) were included in the study. 20 BCVIs were detected in 16 patients (36.3%). The most common injuries identified were Biffl Type II (40%) and Type IV lesions (30%). 86.4% of the patients received a CTA upon admission, 93.2% of which were conducted within 12 h posttrauma. None of the patients had a secondary thrombembolic neurological event during the hospital stay or within 3 months postdischarge. Conclusion Our results indicate that implementation of the screening protocol can prevent strokes in patients without primary thrombembolic neurological deficits.

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Anticoagulation Is the Gold Standard Therapy for Blunt Carotid Injuries to Reduce Stroke Rate

Cothren¹

2004

Arch Surg

271

188

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blunt trauma admissions to our level I center, of which 643 underwent screening angiography for blunt CAI on the basis of a protocol including injury patterns and symptoms. Patients without contraindications underwent anticoagulation immediately for documented lesions.Setting: A state-designated, level I urban trauma center.Patients: Of the 643 patients undergoing screening angiography, 114 (18%) had confirmed CAI.Intervention: Early angiographic diagnosis and prompt anticoagulation.Main Outcome Measures: Diagnosis, stroke rate, and complications stratified by method of intervention.Results: A CAI was identified in 114 patients during the 7-year study period; the majority were men (71%), with a mean±SD age of 34±1.3 years and a mean±SD Injury Severity Score of 29±1.5. Seventy-three patients underwent anticoagulation after diagnosis (heparin in 54, lowmolecular-weight heparin in 2, antiplatelet agents in 17); none had a stroke. Of the 41 patients who did not receive anticoagulation (because of a contraindication in 27, symptoms before diagnosis in 9, and carotid coil or stent in 5), 19 patients (46%) developed neurologic ischemia. Ischemic neurologic events occurred in 100% of patients who presented with symptoms before angiographic diagnosis and those receiving a carotid coil or stent without anticoagulation.Conclusions: Our prospective evaluation of blunt CAIs suggests that early diagnosis and prompt anticoagulation reduce ischemic neurologic events and their disability. The optimal anticoagulation regimen, however, remains to be established.

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The Spectrum of Blunt Injury to the Carotid Artery

Cited by 317 publications

References 0 publications

Blunt Cerebrovascular Injuries

Blunt Cerebrovascular Injuries

Blunt cerebrovascular injuries in acute trauma care: a screening protocol

Anticoagulation Is the Gold Standard Therapy for Blunt Carotid Injuries to Reduce Stroke Rate

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