Computed Tomographic Angiography for the Diagnosis of Blunt Carotid/Vertebral Artery Injury

Malhotra, Ajai K.; Camacho, Marc A.; Ivatury, Rao R.; Davis, Ivan; Komorowski, D.J.; Leung, Daniel A.; Grizzard, John D.; Aboutanos, Michel B.; Duane, Therèse M.; Cockrell, Charlotte; Wolfe, Luke; Borchers, C Todd; Martin, Nancy

doi:10.1097/sla.0b013e3181568cab

Cited by 123 publications

(152 citation statements)

References 26 publications

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“…A significant CTA learning curve has been described in which the diagnostic accuracy of CTA improved with time, with the specificity and negative predictive value climbing to 100% in the latter half of the study. 29 There is great heterogeneity in the reported diagnostic performance of CTA and lack of uniform, unbiased comparison with DSA. Paulus et al 11 reported an improved sensitivity of 64-detector row CTA and 32-detector row CTA, with a sensitivity of 68% and a specificity of 92% in 594 patients who met the screening criteria for BCVI and underwent both CTA and DSA.…”

Section: Discussionmentioning

confidence: 99%

“…3,27,28 However DSA, the reference standard for BCVI detection, continues to be recommended despite being invasive, laborintensive, and available only in specialized centers. 3,4,9,25,[29][30][31] Most injuries missed on CTA are grade I injuries with luminal irregularity, but these have been shown to carry a significant risk of stroke. 3 In a meta-analysis comparing the accuracy of CTA against DSA for BCVI, Roberts et al 10 reported a pooled sensitivity of 66% and specificity of 97% for The incremental effectiveness in all iterations was negative (selective DSA has worse outcomes), and the incremental costs were positive (selective DSA is more expensive), suggesting that selective DSA is less cost-effective than selective CTA.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis

Malhotra¹,

Wu²,

Kalra³

et al. 2015

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis

Malhotra¹,

Wu²,

Kalra³

et al. 2015

AJNR Am J Neuroradiol

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“…In their comparative study of DSA and CTA, Malhotra et al found a specificity of 84% when using CTA to diagnose BCVI (35). The authors alluded to a high false negative rate in the first half of the study which they attributed to the learning curve of reporting radiologists.…”

Section: Computed Tomography Angiography (Cta)mentioning

confidence: 97%

Blunt vertebral vascular injury in trauma patients: ATLS® recommendations and review of current evidence

et al. 2017

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Blunt cerebrovascular injury (BCVI) encompasses two distinct clinical entities: traumatic carotid artery injury (TCAI) and traumatic vertebral artery injury (TVAI). The latter is the focus of our review. These are potentially devastating injuries which pose a diagnostic challenge in the acute trauma setting. There is still debate regarding the optimal screening criteria, diagnostic imaging modality and treatment methods. In 2012 the American College of Surgeons proposed criteria for investigating patients with suspected TVAI and subsequent treatment methods, caveated with the statement that evidence is limited and still evolving. Here we review the historical evidence and recent literature relating to these recommendations.

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“…Studies assessing the accuracy of 16-section multidetector CTA compared with DSA in trauma patients at risk for TCVI found sensitivity, specificity, positive predictive, and negative predictive values of 74%-97.7%, 84%-100%, 63%-100%, and 90%-99.3%, respectively. 8,17 The sensitivity of CTA is increased with greater severity of TCVI. 4 The diagnostic accuracy of CTA, specifically for traumatic aneurysms, particularly small ones, is limited.…”

Section: Value Of Cta For the Diagnosis And Surveillance Imaging Of Tmentioning

confidence: 99%

Extracranial traumatic aneurysms due to blunt cerebrovascular injury

Foreman¹,

Griessenauer²,

Falola

et al. 2014

JNS

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Object. Traumatic aneurysms occur in 10% of extracranial blunt traumatic cerebrovascular injuries (TCVI). The clinical consequences and optimal management of traumatic aneurysms are poorly understood.Methods. A prospective study of TCVI at a Level I trauma center identified 7 patients with 19 extracranial traumatic carotid artery or vertebral artery aneurysms. An additional 6 patients with 7 traumatic aneurysms were followed outside of the prospective study, giving a total of 13 patients with 26 traumatic aneurysms. All patients were treated with 325 mg aspirin daily and underwent clinical and imaging follow-up beyond the initial hospitalization. Endovascular treatment was reserved for aneurysms demonstrating significant enlargement on follow-up imaging. Clinical and radiographic features were assessed.Results. The 7 patients with traumatic aneurysms identified in the prospective cohort comprised 10.3% of all patients with TCVI. Two (15.4%) of the 13 total patients suffered an ischemic stroke in the setting of TCVI with traumatic aneurysm formation. No patient experienced an ischemic stroke or new symptoms after the initiation of antiplatelet therapy. Clinical and radiographic follow-up averaged 15.8 months (range 0.4-41.7 months) and 22.0 months (range 6.6-55.7 months), respectively. Ten (38.5%) of 26 aneurysms were not visualized on last follow-up, 10 (38.5%) were smaller, 1 (3.8%) was unchanged, and 5 (19.2%) were larger. Saccular aneurysms were more likely to enlarge than fusiform aneurysms (33.3% vs 11.8%). Results of a Fisher exact test tend to support the assertion that the 2 different aneurysm morphologies behave differently (p = 0.07). Two saccular aneurysms were treated with stenting.Conclusions. The majority of traumatic aneurysms can be managed with an antiplatelet regimen of 325 mg aspirin daily and serial imaging. Saccular aneurysms have a greater tendency to enlarge when compared with fusiform aneurysms.

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Computed Tomographic Angiography for the Diagnosis of Blunt Carotid/Vertebral Artery Injury

Cited by 123 publications

References 26 publications

Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis

Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis

Blunt vertebral vascular injury in trauma patients: ATLS® recommendations and review of current evidence

Extracranial traumatic aneurysms due to blunt cerebrovascular injury

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