Clinical utility of a screening protocol for blunt cerebrovascular injury using computed tomography angiography

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OBJECTIVE

Blunt cerebrovascular injury (BCVI) occurs in approximately 1% of the blunt trauma population and may lead to stroke and death. Early vascular imaging in asymptomatic patients at high risk of having BCVI may lead to earlier diagnosis and possible stroke prevention. The objective of this study was to determine if the implementation of a formalized asymptomatic BCVI screening protocol with CT angiography (CTA) would lead to improved BCVI detection and stroke prevention.

METHODS

Patients with vascular imaging studies were identified from a prospective trauma registry at a single Level 1 trauma center between 2002 and 2008. Detection of BCVI and stroke rates were compared during the 3-year periods before and after implementation of a consensus-based asymptomatic BCVI screening protocol using CTA in 2005.

RESULTS

A total of 5480 patients with trauma were identified. The overall BCVI detection rate remained unchanged postprotocol compared with preprotocol (0.8% [24 of 3049 patients] vs 0.9% [23 of 2431 patients]; p = 0.53). However, postprotocol there was a trend toward a decreased risk of stroke secondary to BCVI on a trauma population basis (0.23% [7 of 3049 patients] vs 0.53% [13 of 2431 patients]; p = 0.06). Overall, 75% (35 of 47) of patients with BCVI were treated with antiplatelet agents, but no patient developed new or progressive intracranial hemorrhage despite 70% of these patients having concomitant traumatic brain injury.

CONCLUSIONS

The results of this study suggest that a CTA screening protocol for BCVI may be of clinical benefit with possible reduction in ischemic complications. The treatment of BCVI with antiplatelet agents appears to be safe.

ABBREVIATIONSASA = acetylsalicylic acid; BCVI = blunt cerebrovascular injury; CTA = CT angiography; DSA = digital subtraction angiography; GCS = Glasgow Coma Scale; ISS = injury severity score; LOS = length of stay; MRA = MR angiography; mRS = modified Rankin Scale.
Article Information

Contributor Notes

INCLUDE WHEN CITING Published online April 22, 2016; DOI: 10.3171/2016.1.JNS151545.Correspondence John H. Wong, Division of Neurosurgery, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 1403 29 St. NW, Foothills Medical Centre, Calgary, AB T2N 2T9, Canada. email: jwong@ucalgary.ca.

© AANS, except where prohibited by US copyright law.

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