Treatment for Blunt Cerebrovascular Injuries

Cothren, Clay C.

doi:10.1001/archsurg.2009.111

Cited by 198 publications

(35 citation statements)

References 21 publications

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“…There have been efforts to construct evidence-based guidelines for treating BCVI patients [5,9,31]. According to guidelines, the indication criteria for computed tomography angiography (CTA) of cervical arteries would use extended Denver protocol, which includes signs and symptoms for BCVI, e.g., focal neurological deficit, expanding cervical hematoma, neurological deficit inconsistent of head computed tomography (CT), and stroke on CT/magnetic resonance imaging (MRI), or risk factors of BCVI, e.g., high-energy trauma, facial fractures, CSI, and TBI with thoracic injuries [9,13,14]. If these conditions are satisfied, the patient should go through CT angiography, and if BCVI is found, an antithrombotic treatment should be started as early as possible for minimum of 3 months.…”

Section: This Article Is Part Of the Topical Collection On Brain Traumamentioning

confidence: 99%

Occurrence and prognostic effect of cervical spine injuries and cervical artery injuries with concomitant severe head injury

et al. 2020

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Background Blunt cerebrovascular injuries (BCVIs) and cervical spinal injuries (CSIs) are not uncommon injuries in patients with severe head injury and may affect patient recovery. We aimed to assess the independent relationship between BCVI, CSI, and outcome in patients with severe head injury. Methods We identified patients with severe head injury from the Helsinki Trauma Registry treated during 2015-2017 in a large level 1 trauma hospital. We assessed the association between BCVI and SCI using multivariable logistic regression, adjusting for injury severity. Our primary outcome was functional outcome at 6 months, and our secondary outcome was 6-month mortality. Results Of 255 patients with a cervical spine CT, 26 patients (10%) had a CSI, and of 194 patients with cervical CT angiography, 16 patients (8%) had a BCVI. Four of the 16 BCVI patients had a BCVI-related brain infarction, and four of the CSI patients had some form of spinal cord injury. After adjusting for injury severity in multivariable logistic regression analysis, BCVI associated with poor functional outcome (odds ratio [OR] = 6.0, 95% CI [confidence intervals] = 1.4-26.5) and mortality (OR = 7.9, 95% CI 2.0-31.4). We did not find any association between CSI and outcome. Conclusions We found that BCVI with concomitant head injury was an independent predictor of poor outcome in patients with severe head injury, but we found no association between CSI and outcome after severe head injury. Whether the association between BCVI and poor outcome is an indirect marker of a more severe injury or a result of treatment needs further investigations.

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Section: This Article Is Part Of the Topical Collection On Brain Traumamentioning

confidence: 99%

Occurrence and prognostic effect of cervical spine injuries and cervical artery injuries with concomitant severe head injury

et al. 2020

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“…Studies reporting on initially asymptomatic patients treated with antiplatelet agents indicate a risk of stroke of up to 11% [10, 12, 21, 26, 31, 32, 33, 34, 36]. Studies reporting on initially asymptomatic patients treated with anticoagulation indicate a risk of stroke of up to 20% [10, 32].…”

Section: Mechanism and Risk Of Ischemic Strokementioning

confidence: 99%

“…Furthermore, antiplatelet agents carry a theoretical advantage in that the mechanism of stroke in TCVI is usually artery-to-artery embolism, and antiplatelet agents may be more appropriate in the platelet-rich arterial environment. Several retrospective studies have suggested that antiplatelet therapy is equivalent to anticoagulation in terms of neurological outcomes [10, 36, 42]. …”

Section: Antithrombotic Therapymentioning

confidence: 99%

Blunt Traumatic Extracranial Cerebrovascular Injury and Ischemic Stroke

Foreman¹,

Harrigan²

2017

Cerebrovasc Dis Extra

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Background: Ischemic stroke occurs in a significant subset of patients with blunt traumatic cerebrovascular injury (TCVI). The patients are victims of motor vehicle crashes, assaults or other high-energy collisions, and suffer ischemic stroke due to injury to the extracranial carotid or vertebral arteries. Summary: An increasing number of patients with TCVI are being identified, largely because of the expanding use of computed tomography angiography for screening patients with blunt trauma. Patients with TCVI are particularly challenging to manage because they often suffer polytrauma, that is, numerous additional injuries including orthopedic, chest, abdominal, and head injuries. Presently, there is no consensus about optimal management. Key Messages: Most literature about TCVI and stroke has been published in trauma, general surgery, and neurosurgery journals; because of this, and because these patients are managed primarily by trauma surgeons, patients with stroke due to TCVI have been essentially hidden from view of neurologists. This review is intended to bring this clinical entity to the attention of clinicians and investigators with specific expertise in neurology and stroke.

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“…4,5 As a result, growing treatment trends have patients who present with cervical spine trauma screened for cerebrovascular injury before surgical stabilization of the spine so that treatment can be started early. 2,6,7 Cerebrovascular injury can lead to neurovascular complications either from thrombus formation at the tear site or narrowing of the vessel. 8 Anticoagulation treatment begun in the early period (before the onset of stroke symptoms) has been shown to improve mortality and lower neurologic complications, but in patients having spinal surgery it carries the risk of epidural hematoma and major bleeding.…”

Section: Introductionmentioning

confidence: 99%

Cervical Spine Decompression and Fusion Outcomes in Trauma Patients Actively Receiving Anticoagulation Treatment for Cerebrovascular Injury: A Retrospective Comparative Study

Camillo

Mitchell

2020

Int J Spine Surg

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Background: Cervical spine blunt trauma patients with the presence of a cerebrovascular injury may be given initiation of heparin anticoagulation treatment prior to necessary surgical stabilization. Literature regarding the safety and efficacy of these procedures while a patient is on active anticoagulation is limited, requiring further investigation. The primary research question for this study is: Can cervical spine decompression and fusion in the context of a blunt cerebrovascular injury and anticoagulation therapy be completed safely? To accomplish this a comparison of outcomes and perioperative complications was made to a control group. Methods: A total of 63 trauma patients requiring cervical spine decompression and fusion from 2013 to 2015 were identified at our North American level 1 trauma center. Evaluation of patient injury data, bleeding events, postoperative infections, and neurologic outcomes was collected from chart review. The American Spinal Injury Association (ASIA) grading system was used to measure change in postoperative neurologic outcomes. Results: Of 63 patients, 14 had a concomitant cerebrovascular injury that required perioperative anticoagulation treatment. In the 14 patients receiving anticoagulation, 11 had anterior and 3 had posterior stabilization. A total of 2 patients experienced a complication (pneumonia and hardware failure), but neither was related to anticoagulation. An elevated prothrombin time value was noted postoperatively in 1 patient, but with no adverse outcome. No bleeding or thrombotic events, surgical site infection, or neurologic deterioration occurred. The difference in postoperative ASIA grades between groups was not significantly different (P ¼ .57). Conclusions: The operative cohort receiving anticoagulation therapy did not demonstrate an increase affinity for perioperative complications or a decline in ASIA scores postoperatively when compared to a control cohort. Clinical Relevance: Patients with a cerebrovascular injury receiving anticoagulation treatment can undergo safe and successful cervical spine stabilization procedures. Level of Evidence: Therapeutic level III.

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Treatment for Blunt Cerebrovascular Injuries

Cited by 198 publications

References 21 publications

Occurrence and prognostic effect of cervical spine injuries and cervical artery injuries with concomitant severe head injury

Occurrence and prognostic effect of cervical spine injuries and cervical artery injuries with concomitant severe head injury

Blunt Traumatic Extracranial Cerebrovascular Injury and Ischemic Stroke

Cervical Spine Decompression and Fusion Outcomes in Trauma Patients Actively Receiving Anticoagulation Treatment for Cerebrovascular Injury: A Retrospective Comparative Study

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