Clinical utility of a screening protocol for blunt cerebrovascular injury using computed tomography angiography.
OBJECTIVE Blunt cerebrovascular injury (BCVI) occurs in approximately 1% of the blunt trauma population and may lead to stroke and death. Early vascular imaging in asymptomatic patients at high risk of having BCVI may lead to earlier diagnosis and possible stroke prevention. The objective of this study was to determine if the implementation of a formalized asymptomatic BCVI screening protocol with CT angiography (CTA) would lead to improved BCVI detection and stroke prevention. METHODS Patients with vascular imaging studies were identified from a prospective trauma registry at a single Level 1 trauma center between 2002 and 2008. Detection of BCVI and stroke rates were compared during the 3-year periods before and after implementation of a consensus-based asymptomatic BCVI screening protocol using CTA in 2005. RESULTS A total of 5480 patients with trauma were identified. The overall BCVI detection rate remained unchanged postprotocol compared with preprotocol (0.8% [24 of 3049 patients] vs 0.9% [23 of 2431 patients]; p = 0.53). However, postprotocol there was a trend toward a decreased risk of stroke secondary to BCVI on a trauma population basis (0.23% [7 of 3049 patients] vs 0.53% [13 of 2431 patients]; p = 0.06). Overall, 75% (35 of 47) of patients with BCVI were treated with antiplatelet agents, but no patient developed new or progressive intracranial hemorrhage despite 70% of these patients having concomitant traumatic brain injury. CONCLUSIONS The results of this study suggest that a CTA screening protocol for BCVI may be of clinical benefit with possible reduction in ischemic complications. The treatment of BCVI with antiplatelet agents appears to be safe.
Division of Neurosurgery, Department of Clinical Neurosciences.
Michael K
MK
Tso
Division of Cardiac Surgery, University of Toronto, Ontario, Canada.
Myunghyun M
MM
Lee
Department of Surgery, and.
Chad G
CG
Ball
Division of Neuroradiology, Department of Diagnostic Imaging, University of Calgary, Foothills Medical Centre, Calgary, Alberta; and.
William F
WF
Morrish
Division of Neurosurgery, Department of Clinical Neurosciences.|Division of Neuroradiology, Department of Diagnostic Imaging, University of Calgary, Foothills Medical Centre, Calgary, Alberta; and.
Alim P
AP
Mitha
Department of Surgery, and.
Andrew W
AW
Kirkpatrick
Division of Neurosurgery, Department of Clinical Neurosciences.|Division of Neuroradiology, Department of Diagnostic Imaging, University of Calgary, Foothills Medical Centre, Calgary, Alberta; and.
John H
JH
Wong
D000328:Adult; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control; D002533:Cerebral Angiography; D020214:Cerebrovascular Trauma / Q000000981:diagnostic imaging* / Q000209:etiology; D002985:Clinical Protocols; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*
ASA = acetylsalicylic acid; BCVI = blunt cerebrovascular injury; CTA = CT angiography; DSA = digital subtraction angiography; GCS = Glasgow Coma Scale; ISS = injury severity score; LOS = length of stay; MRA = MR angiography; blunt cerebrovascular injury; computed tomography angiography; mRS = modified Rankin Scale; screening; stroke; trauma