The Utility of Short-Interval Repeat Computed Tomography Angiogram After Blunt Cerebrovascular Injury in Adults

Introduction Blunt cerebrovascular injury (BCVI) can lead to thromboembolic events. The necessity of short-interval noninvasive vascular imaging after the initial diagnosis is controversial. This retrospective cohort assesses the utility of short-interval computed tomography angiography (CTA) after an initial diagnosis of BCVI.  Methods We retrospectively reviewed patients with BCVI managed at our institution from 2016 to 2019 who underwent a short-interval (one to three weeks) repeat CTA after initial diagnosis. We excluded patients with age <18 years, penetrating injury, and previous neck irradiation. We collected baseline data and performed logistic regression to identify predictors of BCVI imaging outcomes.  Results The study cohort comprised 38 patients with a mean age of 45 years with 68% males. Motor vehicle crash (MVC) was the most common mechanism of 79% injury. Unilateral vertebral artery (VA) was the most common vessel that is 66% injured, and grade I 36% was the most common dissection on initial CTA. Grades III and IV dissection 33% were the most common in the short-interval CTA. Shift analysis showed a significant improvement in Biffl grades I on the short-interval CTA (p = 0.0001). Antiplatelet therapy or anticoagulation (AC) was administered to 82% of patients after the initial diagnosis. The rates of early (<2 weeks) and delayed (two weeks to three months) ischemia were 5% and 0%, respectively, and endovascular stenting was performed in 8%.  Conclusion BCVI grades I and II are more frequent than high-grade injuries. Short-interval non-invasive vascular imaging can detect changes of BCVI which can affect the management paradigm. It also can select patients who will benefit from endovascular intervention and avoid stroke. Besides, the short-interval non-invasive vascular imaging will not incur additional cost or increase exposure to radiation.