Acute and Long-Term Management of Blunt Cerebrovascular Injury at a Quaternary Referral Level 1 Trauma Center: The Memphis Experience and Comparison of a New Scoring System

Mustafa Motiwala; Vincent N Nguyen; Taylor Orr; Kara A Parikh; Lindsey Erin Miller; Michael Barats; Jordan T Roach; Sean Himel; Bhageeradh Mulpur; Nicolas K Khattar; Andrew J Kerwin; Martin Croce; Adam Arthur; Violiza Inoa-Acosta; Christopher Nickele; Daniel Hoit; Lucas Elijovich; Nitin Goyal; Nickalus R Khan

doi:10.1227/neu.0000000000002988

Acute and Long-Term Management of Blunt Cerebrovascular Injury at a Quaternary Referral Level 1 Trauma Center: The Memphis Experience and Comparison of a New Scoring System

Neurosurgery. 2024 May 20. doi: 10.1227/neu.0000000000002988. Online ahead of print.

Authors

Mustafa Motiwala¹, Vincent N Nguyen², Taylor Orr³, Kara A Parikh¹, Lindsey Erin Miller⁴, Michael Barats⁵, Jordan T Roach³, Sean Himel¹, Bhageeradh Mulpur⁶, Nicolas K Khattar⁶, Andrew J Kerwin⁷, Martin Croce⁷, Adam Arthur^{1

6}, Violiza Inoa-Acosta^{6

8}, Christopher Nickele^{1

6}, Daniel Hoit^{1

6}, Lucas Elijovich^{6

8}, Nitin Goyal^{6

8}, Nickalus R Khan^{1

6}

Affiliations

¹ Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
² Department of Neurosurgery, University of Southern California, Los Angeles, California, USA.
³ College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁴ Department of Neurosurgery, Atrium Health, Charlotte, North Carolina, USA.
⁵ Department of Neurosurgery, Albany Medical College, Albany, New York, USA.
⁶ Semmes-Murphey Clinic, Memphis, Tennessee, USA.
⁷ Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁸ Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.

PMID: 38767366
DOI: 10.1227/neu.0000000000002988

Abstract

Background and objectives: The management of blunt cerebrovascular injuries (BCVIs) remains an important topic within trauma and neurosurgery today. There remains a lack of consensus within the literature and significant variation across institutions. The purpose of this study was to evaluate management of BCVI at a large, tertiary referral trauma center.

Methods: Institutional Review Board approval was obtained to conduct a retrospective review of patients with BCVI at our Level 1 Trauma Center. Computed tomography angiography was used to identify BCVI for each patient. Patient information was collected, and statistical analysis was performed. With the included risk factors for ischemic complications, a novel scoring system based on ischemic risk, the "Memphis Score," was developed and evaluated to grade BCVI.

Results: Two hundred seventeen patients with BCVI from July 2020 to August 2022 were identified. The most common mechanism of injury was motor vehicle collision (141, 65.0%). Vertebral arteries were the most common vessel injured (136, 51.1%) with most injuries occurring at a high cervical location (101, 38.0%). Denver Grade 1 injuries (89, 33.5%) and a Memphis Score of 1 were most frequent (172, 64.6%), and initial anticoagulation with heparin drip was initiated 56.7% of the time (123). Endovascular treatment was required in 24 patients (11.1%) and was usually performed in the first 48 hours (15, 62.5%). While Denver Grade (P = .019) and Memphis Score (P < .00001) were significantly higher in those patients undergoing endovascular treatment, only the Memphis Score demonstrated a significant difference between those patients who had stroke or worsening on follow-up imaging and those who did not (P = .0009).

Conclusion: Although BCVI management has improved since early investigative efforts, institutions must evaluate and share their data to help clarify outcomes. The novel "Memphis Score" presents a standardized framework to communicate ischemic risk and guide management of BCVI.