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Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
Factors associated with stroke formation in blunt cerebrovascular injury: An EAST multicenter study
Emily C Esposito1, Joseph A Kufera, Timothy W Wolff
1From the University of Maryland School of Medicine (E.E., J.A.K., T.M.S., M.H.L.), Baltimore, Maryland; Ohio State University Wexner Medical Center (T.W.W., M.C.S., A.J.Y.), Columbus, Ohio; Greenville Health System (J.S.), Greenville, South Carolina; University of Colorado (J.A.D., L.Z., La.H., An.G.), Boulder, Colorado; Loma Linda University (S.B., P.K.)., Loma Linda, California; Ascension Health (L.E.J., J.W.), St. Louis, Missouri; University of California (J.N., Ar.G.), Oakland, California; University of Miami (M.C., R.R.), Miami, Florida; Perelman School of Medicine at the University of Pennsylvania (J.L.P.), Philadelphia, Pennsylvania; UT Health Tyler (J.M.), Tyler, Texas; Towerhealth (A.W.O., A.M.), West Reading, Pennsylvania; Lehigh Valley Health Network (R.S.S., R.A.), Allentown, Pennsylvania; Tufts University School of Medicine (N.B., A.T.), Boston, Massachusetts; Sanford Health (K.Z., Le.H.), Sioux Falls, South Dakota; Research Medical Center (M.J.L.), Kansas City, Missouri; University of California San Francisco (D.M.S.), San Francisco, California.
Insights
Identifying stroke risk factors after blunt cerebrovascular injury (BCVI) is crucial. Protocol-driven care, Aspirin therapy, and lower stenosis reduce stroke risk, while thrombus formation increases it.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Neurology
Background:
- Stroke risk factors following blunt cerebrovascular injury (BCVI) are not well-defined.
- This study investigated factors contributing to stroke in BCVI patients.
Purpose of the Study:
- To identify predictors of stroke in patients with blunt cerebrovascular injury.
- To analyze the association between medical therapy, radiographic features, and stroke risk in BCVI.
Main Methods:
- A prospective, observational trial involving 16 centers.
- Analysis of stroke risk factors for vertebral artery (VA) and internal carotid artery (ICA) BCVI.
- Data collected during the initial hospitalization.
Main Results:
- Stroke occurred in 8.9% of BCVI cases (11.7% ICA, 6.7% VA).
- Protocol management, trauma service care, and Aspirin therapy were associated with lower stroke rates.
- Higher luminal stenosis, and thrombus resolution/formation were linked to increased stroke risk.
Conclusions:
- Protocol-driven management, Aspirin therapy, and reduced luminal stenosis are associated with decreased stroke risk.
- Thrombus resolution or new formation correlates with higher stroke rates.
- Further research is needed to integrate these findings into BCVI management strategies.
Background:
Stroke risk factors after blunt cerebrovascular injury (BCVI) are ill-defined. We hypothesized that factors associated with stroke for BCVI would include medical therapy (i.e., Aspirin), radiographic features, and protocolization of care.
Methods:
An Eastern Association for the Surgery of Trauma-sponsored, 16-center, prospective, observational trial was undertaken. Stroke risk factors were analyzed individually for vertebral artery (VA) and internal carotid artery (ICA) BCVI. Blunt cerebrovascular injuries were graded on the standard 1 to 5 scale. Data were from the initial hospitalization only.
Results:
Seven hundred seventy-seven BCVIs were included. Stroke rate was 8.9% for all BCVIs, with an 11.7% rate of stroke for ICA BCVI and a 6.7% rate for VA BCVI. Use of a management protocol (p = 0.01), management by the trauma service (p = 0.04), antiplatelet therapy over the hospital stay (p < 0.001), and Aspirin therapy specifically over the hospital stay (p < 0.001) were more common in ICA BCVI without stroke compared with those with stroke. Antiplatelet therapy over the hospital stay (p < 0.001) and Aspirin therapy over the hospital stay (p < 0.001) were more common in VA BCVI without stroke than with stroke. Percentage luminal stenosis was higher in both ICA BCVI (p = 0.002) and VA BCVI (p < 0.001) with stroke. Decrease in percentage luminal stenosis (p < 0.001), resolution of intraluminal thrombus (p = 0.003), and new intraluminal thrombus (p = 0.001) were more common in ICA BCVI with stroke than without, while resolution of intraluminal thrombus (p = 0.03) and new intraluminal thrombus (p = 0.01) were more common in VA BCVI with stroke than without.
Conclusion:
Protocol-driven management by the trauma service, antiplatelet therapy (specifically Aspirin), and lower percentage luminal stenosis were associated with lower stroke rates, while resolution and development of intraluminal thrombus were associated with higher stroke rates. Further research will be needed to incorporate these risk factors into lesion specific BCVI management.
Level Of Evidence:
Prognostic and Epidemiologic, Level IV.
