Vascular Imaging is the Only Reliable Method to Exclude Blunt Cerebrovascular Injury Post Hanging or Strangulation

Strangulation and hanging injuries are a common form of self-inflicted harm. The incidence of associated blunt cerebrovascular injury and its correlation with clinical findings remains unclear. Furthermore, the decision to image and the choice of imaging remains unresolved.

A multicenter retrospective review of a prospectively collected database was performed of all patients who presented with a hanging or strangulation injury. All patients underwent a CT angiogram. Inferential and descriptive statistics were performed. Patient demographics, clinical data, laboratory results, and imaging findings were reviewed.

Over an 11-year period (2013-2023), 194 patients presented with hanging or strangulation type injuries. The median age was 28.7 years, and 24% were female. All patients underwent a CT angiogram with only 9 patients (4.6%) having a positive finding. There was no correlation between positive findings on CT angiogram and any clinical or laboratory finding. The in-hospital mortality rate was 1%, none of whom had an associated vascular injury.

The incidence of vascular injury in strangulation or hanging injuries is 4.6%. In light of the reported incidence of stroke in blunt carotid injury (23%-30%) when left untreated, it is imperative that these injuries are found and treated. Based on the above data, there are no clinical or lab indicators (or combination thereof) that can be safely used to exclude an injury and avoid imaging. Thus, is it advised that all patients are imaged with a CT angiogram.