Timing and mechanism of ischemic stroke due to extracranial blunt traumatic cerebrovascular injury

Griessenauer, Christoph J.; Fleming, James B.; Richards, Boyd F.; Cava, Luis P.; Curé, Joel K.; Younan, Duraid; Zhao, Limin; Alexandrov, Andrei V.; Barlinn, Kristian; Taylor, Tracy; Harrigan, Mark R.

doi:10.3171/2012.11.jns121038

Cited by 57 publications

(72 citation statements)

References 40 publications

(57 reference statements)

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“…10 Griessenauer et al concluded that most ischemic strokes occur before initial screening with CTA, and prior to treatment with an antiplatelet medication, indicating that follow-up imaging may not aid in preventing most ischemic strokes. 12 We have noticed similar findings thus far in our BCVI analysis, with the majority of strokes presenting soon after admission, and frequently prior to the administration of any medication. 25 Similarly, Mayberry et al retrospectively examined cases treated in 2 major trauma centers and noted that all strokes from BCI happened within 12 hours of admission.…”

Section: Discussionsupporting

confidence: 67%

“…From the available literature, however, it is difficult to determine the true rate of BCVIrelated ischemic strokes; there have been reports as low as 0.05% and as high as 50%. 10,12,14,16 In this current study examining low-grade BCI, we identified only 1 patient (1%) who presented with a BCI-related stroke, which is not a dissimilar finding from our earlier report on low-grade BVIs. 25 A previous study from our institution by Eastman et al examined 26 patients with either BCIs and/or BVIs (4 of those patients had a Grade 1 or 2 BCI) and found a stroke rate of 3.8% (1 of 26) in patients with BCVI.…”

Section: Discussioncontrasting

confidence: 33%

“…Common parameters for BCVI screening include patients with symptomatic ischemic injuries and patients who are asymptomatic with Le Fort II or III fractures, cervical spine fractures, Horner's syndrome, foramen lacerum fractures, neck soft-tissue injury, or unexplained ischemic events. 4,12 There have also been case reports of BCVI diagnosis from more benign torsion injuries, such as those reported from common activities such as yoga. [22][23][24] At our institution, trauma patients meeting the criteria for BCVI screening undergo CTA studies.…”

Section: Discussionmentioning

confidence: 99%

“…Griessenauer et al looked at the outcomes in 112 patients with BCVI. 12 This study included both carotid and vertebral artery injuries of various grades and identified only 1 case of ischemic stroke caused by BCVI. From the available literature, however, it is difficult to determine the true rate of BCVIrelated ischemic strokes; there have been reports as low as 0.05% and as high as 50%.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and radiographic outcomes following traumatic Grade 1 and 2 carotid artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey

Scott¹,

Sharp²,

Figueroa

et al. 2015

JNS

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T he management of blunt cerebrovascular injuries (BCVIs), including low-grade blunt carotid artery injuries (BCIs), remains controversial; however, antiplatelet agents or anticoagulation continue to be firstline treatments, with endovascular stenting typically reserved for symptomatic or higher-grade injuries. 5,7,8,16,19,26 Whereas our earlier reports explored blunt vertebral artery injuries (BVIs), this current report presents our evaluation of Grade 1 and 2 BCIs. Imaging, progression of injury, and outcomes of these lower-grade BCIs were analyzed to abbreviatioNs ASA = acetylsalicylic acid; BCI = blunt carotid artery injury; BCVI = blunt cerebrovascular injury; BVI = blunt vertebral artery injury; CTA = CT angiography; DSA = digital subtraction angiography; MVC = motor vehicle collision. obJect Proper screening, management, and follow-up of Grade 1 and 2 blunt carotid artery injuries (BCIs) remains controversial. These low-grade BCIs were analyzed to define their natural history and establish a rational management plan based on lesion progression and cerebral infarction. methods A retrospective review of a prospectively maintained database of all blunt traumatic carotid and vertebral artery injuries treated between August 2003 and April 2013 was performed and Grade 1 and 2 BCIs were identified. Grade 1 injuries are defined as a vessel lumen stenosis of less than 25%, and Grade 2 injuries are defined as a stenosis of the vessel lumen between 25% and 50%. Demographic information, radiographic imaging, number of imaging sessions performed per individual, length of radiographic follow-up, radiographic outcome at end of follow-up, treatment(s) provided, and documentation of ischemic stroke or transient ischemic attack were recorded. results One hundred seventeen Grade 1 and 2 BCIs in 100 patients were identified and available for follow-up. The mean follow-up duration was 60 days. Final imaging of Grade 1 and 2 BCIs demonstrated that 64% of cases had resolved, 13% of cases were radiographically stable, and 9% were improved, whereas 14% radiographically worsened. Of the treatments received, 54% of cases were treated with acetylsalicylic acid (ASA), 31% received no treatment, and 15% received various medications and treatments, including endovascular stenting. There was 1 cerebral infarction that was thought to be related to bilateral Grade 2 BCI, which developed soon after hospital admission. coNclusioNs The majority of Grade 1 and 2 BCIs remained stable or improved at final follow-up. Despite a 14% rate of radiographic worsening in the Grade 1 and 2 BCIs cohort, there were no adverse clinical outcomes associated with these radiographic changes. The stroke rate was 1% in this low-grade BCIs cohort, which may be an overestimate. The use of ASA or other antiplatelet or anticoagulant medications in these low-grade BCIs did not appear to correlate with radiographic injury stability, nor with a decreased rate of cerebral infarction. Although these data suggest that these Grade 1 and 2 BCIs may require less intensive r...

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Section: Discussionsupporting

confidence: 67%

Section: Discussioncontrasting

confidence: 33%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical and radiographic outcomes following traumatic Grade 1 and 2 carotid artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey

Scott¹,

Sharp²,

Figueroa

et al. 2015

JNS

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show abstract

“…When necessary, digital arteriography can be used to provide a clearer picture of the extent of arterial injury. 8 Treatment can be administered via percutaneous access, by embolization or by placement of a covered stent. [9][10][11] Conventional techniques for vascular repair include identification of the orifice allowing communication between artery and vein -of which there is generally only one -followed by a number of possibilities, including lateral suture, end-to-end anastomosis, interposition of a vein graft, repair using patches and ligature.…”

Section: Introductionmentioning

confidence: 99%

Correction of carotid-jugular traumatic fistula using a bovine pericardial patch

et al. 2014

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Carotid-jugular fistulae are rare, but habitually cause morbidity and mortality. They are often linked with penetrating trauma, primarily caused by gunshots. This report describes the case of a patient who was the victim of a gunshot wound to the left cervical area, provoking a carotid-jugular arteriovenous fistula and occlusion of the common carotid artery. The fistula was corrected by ligature of the internal jugular vein and arteriorrhaphy of the left common carotid artery with a bovine pericardium patch.

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The Natural History of Indeterminate Blunt Cerebrovascular Injury

et al. 2015

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Timing and mechanism of ischemic stroke due to extracranial blunt traumatic cerebrovascular injury

Abstract: Most ischemic strokes due to TCVI are embolic in nature and occur prior to screening CTA and initiation of treatment with aspirin.

Cited by 57 publications

References 40 publications

Clinical and radiographic outcomes following traumatic Grade 1 and 2 carotid artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey

Clinical and radiographic outcomes following traumatic Grade 1 and 2 carotid artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey

Correction of carotid-jugular traumatic fistula using a bovine pericardial patch

The Natural History of Indeterminate Blunt Cerebrovascular Injury

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