Neurointerventional management of cerebrovascular trauma

Abstract

Traumatic cerebrovascular injuries following blunt or penetrating trauma are common and carry a high risk of permanent disability or death. Proper screening, diagnosis, and treatment of these lesions is essential to improve patient outcomes. Advances in imaging continue to improve the accuracy of non-invasive diagnosis of these injuries while new clinical data provide better evidence for optimal management, whether medical or invasive. Here, we review screening, diagnosis, and treatment of traumatic cerebrovascular injuries.

Association of Cerebrovascular Injury and Secondary Vascular Insult With Poor Outcomes After Gunshot Wound to the Head in a Large Civilian Population

“…Established guidelines regarding treatment of cerebrovascular injuries after penetrating head trauma have not been established. 11 Data from nonpenetrating mechanisms of CVI can help inform decisions to treat. Studies have shown ∼40% mortality in patients with secondary stroke after blunt traumatic CVI and that antithrombotic treatment was associated with decreased mortality.…”

“…[7][8][9] Little is known about cerebrovascular injury (CVI) in penetrating TBI from civilian GSWH. Interest in this topic is growing [10][11][12] because data are extrapolated from secondary vascular injury after CVI in blunt TBI. 13,14 Most of the literature on traumatic CVI derives from wartime experience with blast injuries and high velocity penetrating TBI.…”

“…10,12 While no consensus has not been reached on the management of CVI in penetrating TBI, most literature supports early screening and treatment to prevent secondary vascular insult, such as delayed stroke or rehemorrhage. 11,13,19 However, to the best of our knowledge, no study on the incidence of secondary vascular insult after CVI from GSWH has been published.…”

Management Patterns and Outcomes After Traumatic Brain Injury With Associated Blunt Cerebrovascular Injury

“…Although these findings may be influenced by the high rate of strokes within the complications category, it is notable that despite being an independent driver of stroke and complications, Biffl grade was not an independent risk factor for patient mortality. In addition, the existing literature primarily reports complication rates associated with surgical/endovascular BCVI management 14,44 but is lacking sufficient data on the association between Biffl grade and other common adverse events (such as deep vein thrombosis, myocardial infarction, pulmonary embolism, and pneumonia). Further research is warranted to explore whether the observed disparity in our study between stroke/complications and patient mortality holds true in other BCVI patient cohorts.…”

Endovascular Treatment for Head and Neck Trauma

“…또한 저자의 기관에서는 우선적으로 인터벤션 치료에 이어 수술적 혈관 재건을 시행하기도 하고 있다. 2022년의 한 종설에 따르면 구역 I에서는 수술적 접근이 가능하며 불가능할 경우 인터벤션 치료, 구역 II의 경우 수술적 접근, 구역 III에서는 인터벤션 치료를 고려하도록 제시한 바 있다( 48 ). 현재는 이전보다 수술적, 인터벤션 치료 양측 모두 발달된 기법과 기구들이 적용 가능하므로 다학제적 접근을 통해서 치료 방침을 적용하는 것이 적절하겠다.…”