The Role of Number of Affected Vessels on Radiologic and Clinical Outcomes of Patients with Blunt Cerebrovascular Injury

Hamidreza Hosseinpour; Louis J Magnotti; Dih-Dih Huang; Jordan A Weinberg; Andrew Tang; Omar Hejazi; Collin Stewart; Sai Krishna Bhogadi; Tanya Anand; Bellal Joseph

doi:10.1016/j.jvs.2024.04.053

The Role of Number of Affected Vessels on Radiologic and Clinical Outcomes of Patients with Blunt Cerebrovascular Injury

J Vasc Surg. 2024 Apr 25:S0741-5214(24)01079-6. doi: 10.1016/j.jvs.2024.04.053. Online ahead of print.

Authors

Affiliations

¹ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA. Electronic address: Hosseinpourh@arizona.edu.
² Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA. Electronic address: lmagnotti@arizona.edu.
³ Department of Surgery, Creighton University School of Medicine, Phoenix Regional Campus, St. Joseph's Hospital Medical Center, Phoenix, Arizona, USA. Electronic address: Dih.huang900@commonspirit.org.
⁴ Department of Surgery, Creighton University School of Medicine, Phoenix Regional Campus, St. Joseph's Hospital Medical Center, Phoenix, Arizona, USA. Electronic address: Jordan.weinberg@commonspirit.org.
⁵ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA. Electronic address: atang@surgery.arizona.edu.
⁶ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA. Electronic address: ohejazi@arizona.edu.
⁷ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA. Electronic address: chstewart@surgery.arizona.edu.
⁸ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA. Electronic address: saikbhogadi@arizona.edu.
⁹ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA. Electronic address: tanyaanand@surgery.arizona.edu.
¹⁰ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA. Electronic address: bjoseph@arizona.edu.

PMID: 38677659
DOI: 10.1016/j.jvs.2024.04.053

Abstract

Objective: There is a lack of data on the role of characteristics of injured vessels on the outcomes of patients with blunt cerebrovascular injuries (BCVIs). The aim of this study was to assess the effect of the number (single vs multiple) of injured vessels on outcomes.

Methods: This is a retrospective study at two ACS level I trauma centers (2017-2021). Adult (>16yr) trauma patients with BCVI are included. Injuries were graded by the Denver Scale based on the initial computed tomography angiography (CTA). Early repeat CTA was performed 7-10 days after diagnosis. Patients were stratified by the number (Single vs. Multiple) of the involved vessels. Outcomes included progression of BCVI on repeat CTA, stroke, and in-hospital mortality attributable to BCVI. Multivariable regression analyses were performed to identify the association between the number of injured vessels and outcomes.

Results: 491 patients with 591 injured vessels (285 carotid and 306 vertebral arteries) were identified. 60% were male, the mean age was 44 years, and the median ISS was 18[11-25]. Overall, 18% had multiple-vessel injuries, 16% had bilateral vessel injuries, and 3% had multiple injuries on the same side. The overall rates of progression to higher-grade injuries, stroke, and mortality were 23%, 7.7%, and 8.8%, respectively. On uni- and multivariable analyses, multiple BCVIs were associated with progression to higher-grade injuries on repeat imaging, stroke, and mortality compared to single-vessel injuries.

Conclusions: BCVIs with multiple injured vessels are more likely to progress to higher grades on repeat CTA, with multiple injuries independently associated with worse clinical outcomes, compared to those with single injuries. These findings highlight the importance of incorporating the number of injured vessels in clinical decision-making and in defining protocols for repeat imaging.

Keywords: Bilateral; Blunt Cerebrovascular Injury; Multiple; Single; Unilateral.