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Blunt cerebrovascular injuries in severe traumatic brain injury: incidence, risk factors, and evolution
Pierre Esnault1, Mickaël Cardinale1, Henry Boret1
1Intensive Care Unit and.
Insights
Blunt cerebrovascular injuries (BCVIs) occur in 9.2% of severe traumatic brain injuries (TBIs). High-risk factors include motorcycle crashes and fractures near cervical arteries, necessitating careful anticoagulation management.
Area of Science:
- Trauma Surgery
- Neurosurgery
- Vascular Surgery
Background:
- Blunt cerebrovascular injuries (BCVIs) affect 1% of trauma patients, requiring anticoagulation to prevent neurovascular events.
- Anticoagulation in severe traumatic brain injury (TBI) patients presents a challenge due to the risk of intracranial hemorrhage expansion.
- Balancing hemorrhagic and ischemic risks is critical for managing patients with both severe TBI and BCVI.
Purpose of the Study:
- To determine the incidence of BCVI in patients with severe TBI.
- To identify risk factors associated with BCVI in the context of severe TBI.
- To evaluate the management and outcomes of BCVI in severe TBI patients.
Main Methods:
- Prospective, observational, single-center study of patients with severe TBI.
- Diagnosis of BCVI using 64-channel multidetector CT.
- Multivariate logistic regression analysis to identify BCVI risk factors.
Main Results:
- BCVI incidence was 9.2% in 228 severe TBI patients over 7 years.
- Key risk factors included motorcycle crashes, carotid canal fractures, cervical spine and thoracic trauma, and hepatic lesions.
- 82% of survivors with BCVI received anticoagulation; overall stroke rate was 19% with one intracranial hemorrhage.
Conclusions:
- Blunt cerebrovascular injuries are common in severe TBI patients, with an incidence of 9.2%.
- High-velocity mechanisms and injuries near cervical arteries are significant risk factors for BCVI.
- Careful consideration of anticoagulation is crucial for managing the dual risks of hemorrhage and ischemia in these patients.
Abstract:
OBJECTIVE Blunt cerebrovascular injuries (BCVIs) affect approximately 1% of patients with blunt trauma. An antithrombotic or anticoagulation therapy is recommended to prevent the occurrence or recurrence of neurovascular events. This treatment has to be carefully considered after severe traumatic brain injury (TBI), due to the risk of intracranial hemorrhage expansion. Thus, the physician in charge of the patient is confronted with a hemorrhagic and ischemic risk. The main objective of this study was to determine the incidence of BCVI after severe TBI. METHODS The authors conducted a prospective, observational, single-center study including all patients with severe TBI admitted in the trauma center. Diagnosis of BCVI was performed using a 64-channel multidetector CT. Characteristics of the patients, CT scan results, and outcomes were collected. A multivariate logistic regression model was developed to determine the risk factors of BCVI. Patients in whom BCVI was diagnosed were treated with systemic anticoagulation. RESULTS In total, 228 patients with severe TBI who were treated over a period of 7 years were included. The incidence of BCVI was 9.2%. The main risk factors were as follows: motorcycle crash (OR 8.2, 95% CI 1.9-34.8), fracture involving the carotid canal (OR 11.7, 95% CI 1.7-80.9), cervical spine injury (OR 13.5, 95% CI 3.1-59.4), thoracic trauma (OR 7.3, 95% CI 1.1-51.2), and hepatic lesion (OR 13.3, 95% CI 2.1-84.5). Among survivors, 82% of patients with BCVI received systemic anticoagulation therapy, beginning at a median of Day 1.5. The overall stroke rate was 19%. One patient had an intracranial hemorrhagic complication. CONCLUSIONS Blunt cerebrovascular injuries are frequent after severe TBI (incidence 9.2%). The main risk factors are high-velocity lesions and injuries near cervical arteries.
