title: Blunt cerebrovascular injuries in severe traumatic brain injury: incidence, risk factors, and evolution.
abstract: OBJECTIVE Blunt cerebrovascular injuries (BCVIs) affect approximately 1% of patients with blunt trauma. An antithrombotic or anticoagulation therapy is recommended to prevent the occurrence or recurrence of neurovascular events. This treatment has to be carefully considered after severe traumatic brain injury (TBI), due to the risk of intracranial hemorrhage expansion. Thus, the physician in charge of the patient is confronted with a hemorrhagic and ischemic risk. The main objective of this study was to determine the incidence of BCVI after severe TBI. METHODS The authors conducted a prospective, observational, single-center study including all patients with severe TBI admitted in the trauma center. Diagnosis of BCVI was performed using a 64-channel multidetector CT. Characteristics of the patients, CT scan results, and outcomes were collected. A multivariate logistic regression model was developed to determine the risk factors of BCVI. Patients in whom BCVI was diagnosed were treated with systemic anticoagulation. RESULTS In total, 228 patients with severe TBI who were treated over a period of 7 years were included. The incidence of BCVI was 9.2%. The main risk factors were as follows: motorcycle crash (OR 8.2, 95% CI 1.9-34.8), fracture involving the carotid canal (OR 11.7, 95% CI 1.7-80.9), cervical spine injury (OR 13.5, 95% CI 3.1-59.4), thoracic trauma (OR 7.3, 95% CI 1.1-51.2), and hepatic lesion (OR 13.3, 95% CI 2.1-84.5). Among survivors, 82% of patients with BCVI received systemic anticoagulation therapy, beginning at a median of Day 1.5. The overall stroke rate was 19%. One patient had an intracranial hemorrhagic complication. CONCLUSIONS Blunt cerebrovascular injuries are frequent after severe TBI (incidence 9.2%). The main risk factors are high-velocity lesions and injuries near cervical arteries.
authors.affiliation: Intensive Care Unit and.
authors.forename: Pierre
authors.initials: P
authors.lastname: Esnault
authors.affiliation: Intensive Care Unit and.
authors.forename: Mickaël
authors.initials: M
authors.lastname: Cardinale
authors.affiliation: Intensive Care Unit and.
authors.forename: Henry
authors.initials: H
authors.lastname: Boret
authors.affiliation: Intensive Care Unit and.
authors.forename: Erwan
authors.initials: E
authors.lastname: D'Aranda
authors.affiliation: Intensive Care Unit and.
authors.forename: Ambroise
authors.initials: A
authors.lastname: Montcriol
authors.affiliation: Intensive Care Unit and.
authors.forename: Julien
authors.initials: J
authors.lastname: Bordes
authors.affiliation: Intensive Care Unit and.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Prunet
authors.affiliation: Department of Neurosurgery, Sainte Anne Military Hospital, Toulon; and.
authors.forename: Christophe
authors.initials: C
authors.lastname: Joubert
authors.affiliation: Department of Neurosurgery, Sainte Anne Military Hospital, Toulon; and.|French Military Health Service Academy Unit, École du Val-de-Grâce, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Dagain
authors.affiliation: Intensive Care Unit and.
authors.forename: Philippe
authors.initials: P
authors.lastname: Goutorbe
authors.affiliation: Intensive Care Unit and.|French Military Health Service Academy Unit, École du Val-de-Grâce, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Kaiser
authors.affiliation: Intensive Care Unit and.|French Military Health Service Academy Unit, École du Val-de-Grâce, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Meaudre
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000628:therapy; D020214:Cerebrovascular Trauma / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D055815:Young Adult
keywords: BCVI = blunt cerebrovascular injury; CAI = carotid artery injury; CTA = CT angiography; DSA = digital subtraction angiography; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICH = intracranial hemorrhage; ICP = intracranial pressure; IQR = interquartile range; ISS = Injury Severity Score; LMWH = low-molecular-weight heparin; ROC = receiver operating characteristic; TBI = traumatic brain injury; VAI = vertebral artery injury; anticoagulation therapy; blunt cerebrovascular injury; cervical artery dissection; traumatic brain injury