Blunt cerebrovascular injuries: diagnosis and management outcomes.
BACKGROUND
Blunt cerebrovascular injury (BCVI) to the carotid and vertebral arteries is a potentially devastating injury in trauma patients. The optimal management for BCVI has not been standardized. At our institution, 64-slice multi-detector computed tomographic angiography (CTA) has been used as the initial screening exam for BCVI in patients who met predefined screening criteria. The purpose of this study is to review the incidence of CTA-diagnosed BCVI in at-risk patients and to evaluate the treatment and clinical outcome of patients with BCVI.


METHODS
This study included trauma patients with a positive diagnosis of BCVI on CTA during a 41-month study period. The medical records and relevant radiographic findings were retrospectively reviewed.


RESULTS
Twenty seven of 222 blunt trauma patients evaluated with CTA had a positive diagnosis of BCVI, with an occurrence rate of 12.2%. Traumatic brain injury (72.2%) and basal skull fractures (55.6%) were the most frequent associated injuries with carotid trauma while 100% of blunt vertebral injuries occurred in the setting of cervical fractures. Fourteen (51.8%) patients received medical therapy; Eleven (40.7%) patients received conservative treatment. Endovascular treatment was attempted in a single case of vertebral arteriovenous fistula. BCVI-related stroke was found in four patients (14.8%), one of whom developed an infarct while on medical treatment.


CONCLUSIONS
BCVI is found in a significant portion of blunt trauma patients with identifiable risk factors, and screening CTA has high diagnostic yield in detecting these lesions. Medical therapy is the mainstay of treatment at our institution; however, BCVI-related stroke may occur despite treatment.
Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
Corie W
CW
Wei
Walter
W
Montanera
Daniel
D
Selchen
Jackie
J
Lian
Christopher
C
Stevens
Lyne Noël
LN
de Tilly
D002533:Cerebral Angiography / Q000379:methods*; D020214:Cerebrovascular Trauma / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D017023:Coronary Angiography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014711:Vertebral Artery / Q000000981:diagnostic imaging; D014949:Wounds, Nonpenetrating / Q000150:complications*