Treatment of asymptomatic blunt cerebrovascular injury (BCVI): a systematic review

Abstract

BackgroundThe management of asymptomatic blunt cerebrovascular injury (BCVI) with respect to stroke prevention and vessel healing is challenging.ObjectivesThe aim of this systematic review was to determine if a specific treatment results in lower stroke rates and/or improved vessel healing in asymptomatic BCVI.Data sourcesAn electronic literature search of MEDLINE, EMBASE, Cochrane Library, CINAHL, SCOPUS, Web of Science, and ClinicalTrials.gov performed from inception to March 2020.Study eligibility criteriaStudies were included if they reported on a comparison of any treatment for BCVI and stroke and/or vessel healing rates.Participants and interventionsAdult patients diagnosed with asymptomatic BCVI(s) who were treated with any preventive medication or procedure.Study appraisal and synthesis methodsAll studies were systematically reviewed and bias was evaluated by the Newcastle-Ottawa Scale. No meta-analysis was performed secondary to significant heterogeneity across studies in patient population, screening protocols, and treatment selection. The main outcomes were stroke and healing rate.ResultsOf 8781 studies reviewed, 19 reported on treatment effects for asymptomatic BCVI and were included for review. Any choice of medical management was better than no treatment, but no specific differences between choice of medical management and stroke outcomes were found. Vessel healing was rare and the majority of healed vessels were following low-grade injuries.LimitationsMajority of the included studies were retrospective and at high risk of bias.Conclusions or implications of key findingsAsymptomatic BCVI should be treated medically using a consistent, local protocol. High-quality studies on the effect of individual antithrombotic agents on stroke rates and vessel healing for asymptomatic BCVI are required.

Current Concepts in Imaging Diagnosis and Screening of Blunt Cerebrovascular Injuries

“…Low molecular weight heparin is recommended [14]. Antiplatelet agents (clopidogrel or aspirin) may show similar efficacy for stroke prevention and are alternatives if the patient has contraindications for heparin [40][41][42][43]. The use of dual antiplatelets has not been shown to be more effective, and may increase the risk of bleeding.…”

Neurointerventional management of cerebrovascular trauma

“…Management of trauma is largely directed towards prevention or mitigation of secondary injury. For example, the increased risk of secondary stroke with BCVI can be dramatically reduced with prompt management 34–36…”

Incidence of Blunt Brain and Neck Injury by Blast in Colombian Military Personnel: A Cases Review

“…Blunt Injury is an intra or extracranial cerebrovascular structural defect that is caused by high-energy non-penetrating trauma [1][2][3] with an incidence ranging between 0.03% and 4.8% among all cases of blunt force trauma [1]. It is considered as an underdiagnosed pathology with a high impact on mortality [4,5].…”

“…It is considered as an underdiagnosed pathology with a high impact on mortality [4,5]. Failure to diagnose it can lead to a 50% increase chance of stroke and a 25% increase chance of mortality [3,6].…”

“…Patients who did not have any type of management and 2. Patients with some type of management where we see that: in patients without treatment, there is a 25% probability of stroke vs management those who have received at least one treatment option, either antiplatelet 8%, anticoagulant 7%, endovascular 5% or with any treatment (3%) [3]. This pathology is frequently described in traffic accidents or falls of heights of more than two or three floors [7] where the mechanism of injury can be found as a direct head trauma of high energy or cervical trauma of hyperflexion, hyperextension and/or rotational; cervical vascular lesions associated with the exercise of chiropractic have also been found [8]; There are the Denver criteria that were extended in 2011 in order to identify the clinical and risk factors associated with blunt injury, this modification managed to increase sensitivity and specificity (97%) and (42%) respectively in the diagnosis [8] these criteria along with those of Memphis can also be used to indicate a radiological screening.…”