A retrospective review was conducted to assess outcomes of blunt cerebrovascular injuries (BCVIs) diagnosed in a 14-month period at a level-1 trauma center and evaluated postdischarge at a single vascular practice. Twenty-nine patients with 34 BCVIs (10 carotid; 24 vertebral) were admitted. Eleven (37.9%) patients were treated with combined anticoagulation and antiplatelet therapy, 9 (31.0%) with anticoagulation, and 4 (13.8%) with antiplatelets. Five (17.2%) patients underwent observation. Seventeen (58.6%) patients (19 injuries) returned for follow-up evaluation. At a mean follow-up of 9.2 weeks, all patients had normal neurological examinations with no complications. Sixteen (84.2%) BCVIs resolved. Anticoagulation and antiplatelet therapies were equally effective in preventing cerebral infarction. Although the majority of lesions resolve, BCVIs have the ability to progress and often require surgical intervention. Routine follow-up after discharge is warranted for all BCVIs and should include repeat computed tomography angiography (CTA) with bilateral carotid/vertebral duplex ultrasound (US) as a physiological test.
Berne JD, Reuland KS, Villarreal DH, McGovern TM, Rowe SA, Norwood SHSixteen-slice multi-detector computed tomographic angiography improves the accuracy of screening for blunt cerebrovascular injury. J Trauma. 2006;60(6):1204-1210.
2.
Biffl WL, Egglin T., Benedetto B., Gibbs F., Cioffi WGSixteen-slice computed tomographic angiography is a reliable noninvasive screening test for clinically significant blunt cerebrovascular injuries. J Trauma. 2006;60(4):745-752.
3.
Biffl WL, Moore EE, Offner PJ, et al. Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 1999;178(6):517-522.
4.
Biffl WL, Moore EE, Ryu RK, et al. The unrecognized epidemic of blunt carotid arterial injuries: early diagnosis improves neurologic outcome. Ann Surg. 1998;228(4):462-470.
5.
Biffl WL, Ray CE Jr, Moore EE, Mestek M., Johnson JL, Burch JMNoninvasive diagnosis of blunt cerebrovascular injuries: a preliminary report . J Trauma. 2002;53(5):850-856.
6.
Biffl WL, Ray CE Jr, Moore EE, et al. Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg. 2002;235(5):699-707.
7.
Cothren CC, Moore EE, Biffl WL, et al. Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg. 2004;139(5):540-546.
8.
Goodwin RB, Beery PR, Dorbish DO, et al. Computed tomographic angiography vs conventional angiography for the diagnosis of blunt cerebrovascular injury in trauma patients. J Trauma.2009;67(5):1046-1050.
9.
Kerwin AJ, Bynoe RP, Murray J., et al. Liberalized screening for blunt carotid and vertebral artery injuries is justified. J Trauma. 2001;51(2):308-314.
10.
Miller PR, Fabian TC, Bee TK, et al. Blunt cerebrovascular injuries: diagnosis and treatment. J Trauma. 2001;51():279-286.
11.
Miller PR, Fabian TC, Croce MA, et al. Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg. 2002;236(3):386-395.
12.
Rogers FB, Baker EF, Osler TM, Shackford SR, Wald SL, Vieco P.Computed tomographic angiography as a screening modality for blunt cervical arterial injuries: preliminary results. J Trauma. 1999;46(3):380-385.
13.
Stein DM, Boswell S., Sliker CW, Lui FY, Scalea TMBlunt cerebrovascular injuries: does treatment always matter? J Trauma. 2009;66(1):132-144.
14.
Berne JD, Norwood SH, McAuley CE, Vallina VL, Creath RG, McLarty J.The high mortality of blunt cerebrovascular injury in an unscreened population: more evidence of the need for mandatory screening protocols. J Am Coll Surg. 2001;192(3):314-321.
15.
Berne JD, Norwood SH, McAuley CE, Villareal DHHelical computed tomographic angiography: an excellent screening test for blunt cerebrovascular injury. J Trauma. 2004 ;57(1):11-19.
16.
Cothren CC, Moore EE, Ray CE Jr, et al. Screening for blunt cerebrovascular injuries is cost-effective . Am J Surg. 2005;190(6): 845-849.
17.
Eastman AL, Chason DP, Perez CL, McAnulty AL, Minei JPComputed tomographic angiography for the diagnosis of blunt cervical vascular injury: is it ready for primetime? J Trauma. 2006;60(5):925-929.
18.
Malhotra AK , Camacho M., Ivatury RR, et al. Computed tomographic angiography for the diagnosis of blunt carotid/vertebral artery injury: a note of caution . Ann Surg. 2007;246(4):632-643.
19.
McKevitt EC , Kirkpatrick AW, Vertesi L., Granger R., Simons RKBlunt vascular neck injuries: diagnosis and outcomes of extracranial vessel injury. J Trauma. 2002;53(3):472-476.
20.
Risgaard O. , Sugrue M., D’Amours S., et al. Blunt cerebrovascular injury: an evaluation from a major trauma centre. ANZ J Surg . 2007;77(8):686-689.
21.
Utter GH, Hollingworth W., Hallam DK. Sixteen-slice CT angiography in patients with suspected blunt carotid and vertebral artery injuries. J Am Coll Surg. 2006;203(6):838-848.
22.
Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Burch JMBlunt carotid arterial injuries: implications of a new grading scale. J Trauma. 1999;47(5):845-853.
23.
Biffl WL, Moore EE, Offner PJ, Burch JMBlunt carotid and vertebral arterial injuries. World J Surg . 2001;25(8):1036-1043.
24.
Carrillo EH , Osborne DL, Spain DA, Miller FB, Senler SO, Richardson JDBlunt carotid artery injuries: difficulties with the diagnosis prior to neurologic event. J Trauma. 1999;46(6):1120-1125.
25.
Cothren CC, Moore EE, Biffl WL, et al. Cervical spine fracture patterns predictive of blunt vertebral artery injury. J Trauma. 2003;55(5):811-813.
Biffl WL, Moore EE, Elliott JP, et al. The devastating potential of blunt vertebral arterial injuries . Ann Surg. 2000;231(5):672-681.
28.
Cothren CC, Moore EE, Ray CE Jr, et al. Carotid artery stents for blunt cerebrovascular injury: risks exceed benefits. Arch Surg. 2005;140(5):480-486.
29.
Mayberry JC , Brown CV, Mullins RJ, et al. Blunt carotid artery injury: the futility of aggressive screening and diagnosis. Arch Surg. 2004;139(6):609-613.
30.
Scheid R., Zimmer C., Schroeter ML, Ballaschke O., von Cramon DYThe clinical spectrum of blunt cerebrovascular injury. Neurologist . 2006;12(5):255-262.
31.
Landwehr P. , Schulte O., Voshage G.Ultrasound examination of carotid and vertebral arteries. Eur Radiol. 2001;11(9):1521-1534.
32.
Colella JJ, Diamond DLBlunt carotid injury: reassessing the role of anticoagulation. Am Surg. 1996;62(3):212-217.
33.
Eachempati SR, Vaslef SN, Sebastian MW, Reed RL 2nd.Blunt vascular injuries of the head and neck: is heparinization necessary?J Trauma. 1998;45(6):997-1004.
34.
Fabian TC, Patton JH Jr, Croce MA, Minard G., Kudsk KA, Pritchard FEBlunt carotid injury. Importance of early diagnosis and anticoagulant therapy . Ann Surg. 1996;223(5):513-525.
35.
Wahl WL, Brandt MM, Thompson BG, Taheri PA, Greenfield LJAntiplatelet therapy: an alternative to heparin for blunt carotid injury. J Trauma. 2002;52(5):896-901.
36.
Baker SP, O’Neill B., Haddon W. Jr, Long WBThe injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187-196.
37.
Hughes KM, Collier B., Greene KA, Kurek S.Traumatic carotid artery dissection: a significant incidental finding. Am Surg. 2000;66(11):1023-1027.
38.
Kraus RR, Bergstein JM, DeBord JRDiagnosis, treatment, and outcome of blunt carotid arterial injuries. Am J Surg. 1999; 178(3):190-193.
39.
Parikh AA, Luchette FA, Valente JF, et al. Blunt carotid artery injuries. J Am Coll Surg . 1997;185(1):80-86.
40.
Inamasu J., Guiot BHVertebral artery injury after blunt cervical trauma: an update. Surg Neurol. 2006;65(3):238-246.
41.
Schneidereit NP, Simons R., Nicolaou S., et al. Utility of screening for blunt vascular neck injuries with computed tomographic angiography. J Trauma . 2006;60(1):209-216.
42.
Veras LM, Pedraza-Gutierrez S., Castellanos J., et al. Vertebral artery occlusion after acute cervical spine trauma . Spine. 2000; 25(9):1171-1177.
43.
Edwards NM, Fabian TC, Claridge JA, Timmons SD, Fischer PE, Croce MAAntithrombotic therapy and endovascular stents are effective treatment for blunt carotid injuries: results from longterm follow-up. J Am Coll Surg. 2007;204(5): 1007-1013.
44.
Berge E., Sandercock P.Anticoagulants versus antiplatelet agents for acute ischaemic stroke. Cochrane Database Syst Rev. 2002;4: CD003242.
45.
Berne JD, Reuland KS, Villarreal DH, McGovern TM, Rowe SA, Norwood SHInternal carotid artery stenting for blunt carotid artery injuries with an associated pseudoaneurysm. J Trauma. 2008;64(2):398-405.
46.
Coldwell DM , Novak Z., Ryu RK, et al. Treatment of posttraumatic internal carotid arterial pseudoaneurysms with endovascular stents. J Trauma. 2000;48(3):470-472.
47.
DuBose J., Recinos G., Teixeira PG, Inaba K., Demetriades D.Endovascular stenting for the treatment of traumatic internal carotid injuries: expanding experience. J Trauma. 2008;65(6): 1561-1566.
48.
Yi AC, Palmer E., Luh GY, Jacobson JP, Smith DCEndovascular treatment of carotid and vertebral pseudoaneurysms with covered stents. AJNR Am J Neuroradiol. 2008;29(5):983-987.
