Impact of operative intervention in blunt cerebral vascular injury

Blunt cerebrovascular injury (BCVI) occurs in 3-7% of patients with blunt trauma and has the potential to lead to stroke. The effectiveness of surgical intervention for BCVI remains uncertain due to a lack of comprehensive data on current techniques.

We analyzed data from the American College of Surgeons National Trauma Databank (NTDB). Patients with BCVI were divided into two cohorts with and without surgical management for comparison. We hypothesized that those managed operative for BCVI would have worse injury profiles and outcomes than non-operative patients.

From 2017-2024, there were a total of 9369,340 encounters in the NTDB database, of which 65,171 (0.7%) had a BCVI. Those in the non-operative management group had lower composite injury severity scores (20 vs. 24, p < 0.001). Of those with a BCVI, 1394 (2.1%) received an endovascular intervention, 248 (<1.0%) received an open vascular intervention, and 25 (<1.0%) received both. Overall, 2062 were diagnosed with a stroke (3%). Among those undergoing endovascular intervention, 201 (14%) were diagnosed with a stroke. Among those undergoing open vascular intervention, 26 (10%) were diagnosed with a stroke. There was no difference in survival to discharge between the two cohorts (non-surgical 87% vs. surgical 86%, p = 0.062). The proportion undergoing interventions for BCVI decreased over the study period.

These data show that patients undergoing operative management of BCVI are generally more severely injured with higher stroke rates. Despite this, there was no significance difference in survival to discharge between operative and non-operative cohorts.