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The role of number of affected vessels on radiologic and clinical outcomes of patients with blunt cerebrovascular
Hamidreza Hosseinpour1, Louis J Magnotti1, Dih-Dih Huang2
1Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ.
Journal of Vascular Surgery
|April 27, 2024
Summary
Multiple blunt cerebrovascular injuries (BCVIs) are linked to worse outcomes, including injury progression, stroke, and mortality, compared to single BCVIs. This highlights the importance of vessel count in managing BCVIs.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Neuroradiology
Background:
- Blunt cerebrovascular injuries (BCVIs) are a significant concern in trauma patients.
- Limited data exists on how the number of injured vessels impacts BCVI patient outcomes.
- Understanding these characteristics is crucial for effective clinical management.
Purpose of the Study:
- To evaluate the impact of the number of injured vessels (single vs. multiple) on patient outcomes.
- To assess the association between multiple BCVIs and adverse clinical events.
- To inform clinical decision-making and imaging protocols for BCVI patients.
Main Methods:
- Retrospective study at two Level I trauma centers (2017-2021).
- Included adult trauma patients diagnosed with BCVIs via computed tomography angiography (CTA).
- Injuries graded using the Denver Scale; repeat CTA performed 7-10 days post-diagnosis. Patients stratified by single vs. multiple vessel injuries. Multivariable regression analyses used.
Main Results:
- 491 patients with 591 injured vessels (285 carotid, 306 vertebral) were analyzed.
- 23% experienced injury progression, 7.7% had a stroke, and 8.8% had BCVI-related mortality.
- Multiple BCVIs were independently associated with higher rates of progression, stroke, and mortality compared to single injuries.
Conclusions:
- Multiple injured vessels in BCVIs correlate with a higher likelihood of progression to more severe injury grades.
- Multiple vessel involvement is an independent predictor of worse clinical outcomes, including stroke and mortality.
- The number of injured vessels should be a key factor in clinical decision-making and repeat imaging protocols for BCVIs.
