Neurologic Outcome of Patients with Blunt Traumatic Aortic Injury: An Observational Single-Center Cohort Study

Evidence on blunt traumatic aortic injury (BTAI)-associated neurological complications is limited. We aimed to assess their prevalence and long-term impact.

This single-center retrospective cohort study included consecutive BTAI patients treated at the University Hospital of Innsbruck (2005-2023). This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Patients were identified by keyword search and confirmed by 2 independent raters; clinical records and imaging were reviewed, and neurologic diagnoses adjudicated by 2 independent neurologists.

Eighty-six BTAI patients were included. Concomitant neurologic pathologies were present in 51 of 86 (59.3%) cases, including traumatic brain injury (TBI) diagnoses (intracranial bleeding 30.2%, diffuse axonal injury 15.1%, and skull fractures 10.5%), potentially vascular- or treatment-related cerebral ischemia (11.6%), trauma-related cervical artery dissections (8.1%), peripheral nerve injuries (10.5%), and spinal cord injuries (7.0%). In-hospital complications included 10 cases (11.6%) of neurologic worsening (National Institute of Health Stroke Scale or modified Rankin Scale [mRS] increase ≥1), with 1 of the seven intrahospital deaths being due to a neurologic cause. Of 86 BTAI patients, 51 (59.3%) had neurologic pathologies-TBI (55.8%), cerebral ischemia (11.6%), peripheral nerve (10.5%), cervical artery dissection (8.1%), and spinal cord injuries (7.0%). 10 (11.6%) had in-hospital neurologic worsening; one of seven deaths was neurologic. Upon follow-up (median 6.8 years), 40.5% remained functionally dependent (mRS >1). Higher Glasgow Coma Scale was associated with lower in-hospital mortality (OR: 0.833; 95% confidence interval [CI]: 0.717, 0.969), concomitant neurologic injuries (OR: 0.692; 95% CI: 0.536, 0.893), and functional dependence (OR: 0.782; 95% CI: 0.651, 0.940; P = 0.009). Higher Injury Severity Score showed the reverse for mortality (OR: 1.063 [1.022, 1.106]; P = 0.002), neurologic injuries (OR: 1.077 [1.025, 1.131]; P = 0.003), and dependency (OR: 1.191 [1.061, 1.336]; P = 0.003). Only three of 33 (9.1%) thoracic endovascular aortic repair (TEVAR)-related °III-subclavian steal cases were symptomatic, all with upper extremity ischemia.

Concomitant neurologic pathologies in BTAI are frequent and have long-term impact, underscoring the need for multidisciplinary care with neurologic screening and early neurorehabilitation; TEVAR-associated subclavian steal had minimal clinical impact.