Angiographic detection of carotid and vertebral arterial injury in the high-energy blunt trauma patient.
OBJECTIVE
Injury to the carotid and vertebral arteries is an identified risk to patients after blunt high-energy cranio-cervical trauma with an associated risk of thromboembolic stroke. We sought to determine the incidence, features, and risk factors of arterial injury using selective cerebral angiography in a high-risk trauma patient subset.


METHODS
Blunt trauma patients with a high-energy mechanism were selected to undergo screening cerebral angiography if they met one of the following criteria: (1) cervical spine hyperextension/hyperflexion injury, (2) skull-base or facial fracture, (3) lateralizing neurologic deficit, ischemic deficit, or cerebral infarction, or (4) hemorrhage of arterial origin.


RESULTS
Of 69 screened patients 20 were found to have a vascular injury (28.9%), including 13 carotid and 15 vertebral; 9 of the 20 patients with vascular injury were symptomatic (45%). The most frequent injuries were intimal dissections (8/28), pseudoaneurysms (6/28), and vessel occlusions (5/28); 8 lesions were intracranial and 20 cervical. Displaced facial fractures (P<0.02) but not skull-base fracture were predictive of carotid injury; multilevel cervical spine fractures (P<0.001) and transverse foraminal fractures (P<0.02) were associated with vertebral injury.


CONCLUSIONS
Cerebral angiography in a selected group of trauma patients was found to yield a significant rate of carotid and vertebral arterial injury, a finding that had implications to subsequent clinical management.
Department of Neurosurgery, Tufts-New England Medical Center, Boston, MA 02111, USA.
Daniel A
DA
Hoit
Clemens M
CM
Schirmer
Simcha J
SJ
Weller
Alan
A
Lisbon
Jonathan A
JA
Edlow
Adel M
AM
Malek
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002533:Cerebral Angiography; D005260:Female; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000453:epidemiology; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging* / Q000453:epidemiology*