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Abstract
Introduction Blunt cerebrovascular injury (BCVI) can lead to thromboembolic events. The necessity of short-term repeat vascular imaging after the initial diagnosis is controversial. The aim of this retrospective cohort study is to assess the utility of short-interval computed tomography angiography (CTA) after an initial diagnosis of BCVI.
Methods We retrospectively reviewed consecutive patients with BCVI managed at the University of Louisville from 2016–2019 who underwent short-term (1–3 weeks) repeat CTA after initial diagnosis. The exclusion criteria were age <18 years, penetrating injury, and previous neck irradiation. We collected baseline data and performed logistic regression analysis to identify predictors of BCVI imaging outcomes.
Results The study cohort comprised 38 patients (68% male) with a mean age of 45 years. Motor vehicle accident (79%) was the most common mechanism of injury, and 89% had cervical spine fractures. Unilateral VA and grade I dissection were the most common findings on initial CTA were a unilateral VA dissection (66%) that was Biffl grade I (36%). Antiplatelet therapy or anticoagulation was administered to 82% of patients after the initial diagnosis (table 1). Shift analysis showed a significant improvement in Biffl grades on repeat CTA (p=0.0001) (figure 1). Biffl grades I injuries were more likely to improve (relative risk ratio [RRR]=3.6, CI 95% (1.02–13.1),p=0.04), whereas grade IV injuries were more likely to be stable (RRR=33, CI 95% (2.9–374), p=0.005). Ten BCVIs (26%) completely resolved on repeat imaging (table 2). The rates of early (<2 weeks) and delayed (2 weeks to 3 months) ischemia were 5% and 0%, respectively. Endovascular stenting was performed in 8%.
Conclusion Short-term repeat non-invasive vascular imaging can help to identify the evolution of BCVI. Repeat vascular imaging at short intervals can help to identify patients who may require endovascular intervention, but additional studies are necessary to clarify its role in the management of BCVI.
Disclosures Z. Aljuboori: None. K. Meyer: None. R. James: None. D. Ding: None.