Angiographic frequency of blunt cerebrovascular injury in patients with carotid canal or vertebral foramen fractures on multidetector CT.
OBJECTIVE
Blunt carotid injuries (BCI's) and blunt vertebral artery injuries (BVI's), known jointly as BCVI's, are common in "high risk" patients. The purpose is to evaluate the rate of occurrence of BCI/BVI in patients screened purely by the radiologic criteria of fracture through the carotid canal or vertebral transverse foramina, or significant cervical subluxation, noted by multidetector CT.


METHODS
Seventy-one patients with 108 catheterized vessels were included over a 13-month interval. The angiographic examinations were prompted by current hospital protocol, solely by the presence of fractures involving/adjacent to the carotid canal, cervical fractures involving/adjacent to the foramen transversarium, or cervical fractures with significant subluxation. The incidence of each grade of blunt injury was calculated after review of the CT scans and catheter angiograms by two neuroradiologists.


RESULTS
Two thousand and seventy-three total blunt trauma admissions occurred during the time period, with a BCVI rate of 0.92-1.0% (depending on the reviewer), similar to previous studies. Mean time to catheter angiography was 16.6 h. Of the 71 included patients, there were 11-12 BCI's and 10-12 BVI's, an overall rate of 27-30% of BCVI in the patients with foraminal fractures. Interobserver agreement in reviewing the catheter angiograms was excellent (Kappa 0.795). Of note, three internal carotid pseudoaneurysms resolved spontaneously after anticoagulation or aspirin.


CONCLUSIONS
This study confirms that there is a high rate of BCVI in the presence of carotid canal or vertebral foramen fractures that are noted by multidetector CT. Utilization of purely radiologic criteria of foraminal involvement may be a significant screening tool in the decision of whether to evaluate these patients acutely by catheter or CT angiography, and for early detection of patients at risk for symptomatology, to initiate prompt, prophylactic treatment.
McKinney
Alexander
A
Department of Radiology, Hennepin County & University of Minnesota-Fairview & Medical Centers, Minneapolis, MN 55415, USA. mckin022@umn.edu
Ott
Frederick
F
Short
James
J
McKinney
Zeke
Z
Truwit
Charles
C
D000328:Adult; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D020212:Carotid Artery Injuries / Q000175:diagnosis* / Q000453:epidemiology; D002533:Cerebral Angiography / Q000379:methods*; D020214:Cerebrovascular Trauma / Q000175:diagnosis* / Q000453:epidemiology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014283:Triiodobenzoic Acids; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000293:injuries; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000453:epidemiology
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol