Citation

Harrigan MR, Griffin RL, Deveikis JP, Prattipati V, Chimowitz MI, Jansen JO. J. Trauma Acute Care Surg. 2020; ePub(ePub): ePub.

Affiliation

Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama Department of Radiology, Johns Hopkins All Childrens Hospital, St. Petersburg, Florida Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama Department of Neurology, Medical University of South Carolina, Charleston, South Carolina Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama.

Copyright

(Copyright © 2020, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002660

PMID

32176175

Abstract

BACKGROUND: Patients with blunt cerebrovascular injuries (BCVI) are at risk of thromboembolic stroke. Although primary prevention with antithrombotic therapy is widely used in this setting, its effectiveness is not well defined, and requires further investigation. The aim of this study was to evaluate the utility of MRI-detected ischemic brain lesions as a possible future outcome for randomized clinical trials in this patient population.

METHODS: This prospective observational study included 20 adult blunt trauma patients admitted to a level I trauma center with a screening neck CTA showing extracranial carotid or vertebral artery injury. All subjects lacked initial evidence of an ischemic stroke and were managed with antithrombotic therapy and observation, and then underwent brain magnetic resonance imaging (MRI) within 30 days of the injury to assess for ischemic lesions. The MRI scans included diffusion, susceptibility, and FLAIR sequences, and were reviewed by two neuroradiologists blinded to the CTA findings.

RESULTS: ll CTAs were done in the Emergency Department upon admission. There were 12 carotid artery dissections and 11 unilateral or bilateral vertebral artery injuries. Median interval between injury and MRI scan was 4 days (range 0.1-14, interquartile range 3-7 days). Diffusion weighted imaging evidence of new ischemic lesions was present in 10 out of 23 (43%) of the injured artery territories. In those injuries with ischemic lesions, the median number was 8 (range 2-25, interquartile range 5-8). None of the lesions were symptomatic. BVCI was associated with a higher mean ischemic lesion count (mean count 3.17 vs. 0.14, p<0.0001), with the association remaining after adjusting for injury severity score (p<0.0001).

CONCLUSION: In asymptomatic blunt trauma patients with CTA evidence of extracranial cerebrovascular injury, and treated with antithrombotic therapy, nearly half of arterial injuries are associated with ischemic lesions on MRI. LEVEL OF EVIDENCE: therapeutic/care management, level IV.

Language: en