Postdischarge outcomes of blunt cerebrovascular injuries

Vasc Endovascular Surg. 2010 Apr;44(3):198-211. doi: 10.1177/1538574409359429.

Abstract

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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anticoagulants / therapeutic use*
  • Carotid Artery Injuries / complications
  • Carotid Artery Injuries / diagnosis
  • Carotid Artery Injuries / therapy*
  • Cerebral Infarction / etiology
  • Cerebral Infarction / prevention & control
  • Cerebrovascular Trauma / complications
  • Cerebrovascular Trauma / diagnosis
  • Cerebrovascular Trauma / therapy*
  • Coronary Angiography / methods
  • Drug Therapy, Combination
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Discharge*
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Retrospective Studies
  • Severity of Illness Index
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Ultrasonography, Doppler, Transcranial
  • Vascular Surgical Procedures*
  • Vertebral Artery / diagnostic imaging
  • Vertebral Artery / injuries*
  • Wounds, Nonpenetrating / complications
  • Wounds, Nonpenetrating / diagnosis
  • Wounds, Nonpenetrating / therapy*
  • Young Adult

Substances

  • Anticoagulants
  • Platelet Aggregation Inhibitors