TY - JOUR
T1 - Blunt cerebrovascular injury
T2 - incidence and long-term follow-up
AU - Hundersmarck, Dennis
AU - Slooff, Willem Bart M.
AU - Homans, Jelle F.
AU - van der Vliet, Quirine M.J.
AU - Moayeri, Nizar
AU - Hietbrink, Falco
AU - de Borst, Gert J.
AU - Öner, Fetullah Cumhur
AU - Muijs, Sander P.J.
AU - Leenen, Luke P.H.
N1 - Funding Information:
Prof. Dr. P.A. De Jong (Pim), Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Publisher Copyright:
© 2019, The Author(s).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
Funding Information:
Prof. Dr. P.A. De Jong (Pim), Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Publisher Copyright:
© 2019, The Author(s).
PY - 2021/2
Y1 - 2021/2
N2 - PURPOSE: Blunt cerebrovascular injuries (BCVI), which can result in ischemic stroke, are identified in 1-2% of all blunt trauma patients. Computed tomography angiography (CTA) scanning has improved and is the diagnostic modality of choice in BCVI suspected patients. Data about long-term functional outcomes and the incidence of ischemic stroke after BCVI are limited. The aim of this study was to determine BCVI incidence in relation to imaging modality improvements and to determine long-term functional outcomes.METHODS: All consecutive trauma patients from 2007 to 2016 with BCVI were identified from the level 1 trauma center prospective trauma database. Three periods were identified where CTA diagnostic modalities for trauma patients were improved. Long-term functional outcomes using the EuroQol six-dimensional (EQ-6D™) were determined.RESULTS: Seventy-one BCVI patients were identified among the 12.122 (0.59%) blunt trauma patients. In the first period BCVI incidence among the overall study cohort, polytrauma, basilar skull fracture and cervical trauma subgroups was found to be 0.3%, 0.9%, 1.2%, 4.6%, respectively, which more than doubled towards the third period (0.8, 2.4, 1.9 and 8.5% respectively). Ischemic stroke as a result of BCVI was found in 20 patients (28%). In-hospital stroke rate was lower in patients receiving antiplatelet therapy (p < 0.01). Six in-hospital deaths were BCVI related. Long-term follow-up (follow-up rate of 83%) demonstrated lower functional outcomes compared to Dutch reference populations (p < 0.01). Ischemic stroke was identified as a major cause of functional impairment at long-term follow-up.CONCLUSIONS: Improved CTA diagnostic modalities have increased BCVI incidence. Furthermore, BCVI patients reported significant functional impairment at long-term follow-up. Antiplatelet therapy showed a significant effect on in-hospital stroke rate reduction.
AB - PURPOSE: Blunt cerebrovascular injuries (BCVI), which can result in ischemic stroke, are identified in 1-2% of all blunt trauma patients. Computed tomography angiography (CTA) scanning has improved and is the diagnostic modality of choice in BCVI suspected patients. Data about long-term functional outcomes and the incidence of ischemic stroke after BCVI are limited. The aim of this study was to determine BCVI incidence in relation to imaging modality improvements and to determine long-term functional outcomes.METHODS: All consecutive trauma patients from 2007 to 2016 with BCVI were identified from the level 1 trauma center prospective trauma database. Three periods were identified where CTA diagnostic modalities for trauma patients were improved. Long-term functional outcomes using the EuroQol six-dimensional (EQ-6D™) were determined.RESULTS: Seventy-one BCVI patients were identified among the 12.122 (0.59%) blunt trauma patients. In the first period BCVI incidence among the overall study cohort, polytrauma, basilar skull fracture and cervical trauma subgroups was found to be 0.3%, 0.9%, 1.2%, 4.6%, respectively, which more than doubled towards the third period (0.8, 2.4, 1.9 and 8.5% respectively). Ischemic stroke as a result of BCVI was found in 20 patients (28%). In-hospital stroke rate was lower in patients receiving antiplatelet therapy (p < 0.01). Six in-hospital deaths were BCVI related. Long-term follow-up (follow-up rate of 83%) demonstrated lower functional outcomes compared to Dutch reference populations (p < 0.01). Ischemic stroke was identified as a major cause of functional impairment at long-term follow-up.CONCLUSIONS: Improved CTA diagnostic modalities have increased BCVI incidence. Furthermore, BCVI patients reported significant functional impairment at long-term follow-up. Antiplatelet therapy showed a significant effect on in-hospital stroke rate reduction.
KW - Blunt cerebrovascular injury
KW - Carotid artery injury
KW - Functional outcomes
KW - Patient-reported outcomes
KW - Vertebral artery injury
UR - http://www.scopus.com/inward/record.url?scp=85067657755&partnerID=8YFLogxK
U2 - 10.1007/s00068-019-01171-9
DO - 10.1007/s00068-019-01171-9
M3 - Article
C2 - 31197394
AN - SCOPUS:85067657755
SN - 1863-9933
VL - 47
SP - 161
EP - 170
JO - European Journal of Trauma and Emergency Surgery
JF - European Journal of Trauma and Emergency Surgery
IS - 1
ER -