Blunt vascular injuries of the carotid and vertebral arteries: should we screen the asymptomatic trauma patients at high risk? Preliminary results of a prospective cohort study

Introduction

Blunt cerebrovascular injuries (BCVI) are more common than previously reported and, if not promptly recognized and treated, may have devastating sequelae. When these injuries are diagnosed before the onset of stroke, and patients receive early antiplatelet or anticoagulation therapy, a substantial reduction in BCVI-related neurologic events has been demonstrated [1].

Methods

The study setting was a level 1 trauma center with a catchment population of more than 2 million people, admitting 350 major traumas yearly. To assess the incidence of asymptomatic BCVI in the severely injured patients, we planned a prospective cohort study. According to the study design, all of the severely injured patients presenting with at least one of the following criteria [2] were submitted to a screening 16-channel CT angiography within 24 hours from admission: diffuse axonal injuries; fracture of the cervical vertebrae or of the skull base; Lefort II or III or other severe facial fractures.

Results

During the first 5 months of the study, 24 major trauma patients (ISS >15) with at least one of the above listed risk factors were submitted to a screening CT angiography for BCVI. All of the patients were sedated and artificially ventilated. None of them was symptomatic for stroke. Three patients (12.5%) in this high-risk group had an asymptomatic BCVI: pseudoaneurysm (one), traumatic stenosis (one) or dissection (one) of the carotid artery. They were immediately treated with antiplatelet therapy (clopidogrel + aspirin). They experienced no episodes of cerebral infarction and no cerebral haemorrhage.

Conclusions

There are limited data in the literature on traumatic BCVI. The available data as well as the preliminary results of our prospective study show that BCVI are more common than previously recognized. Aggressive screening and earlier therapy may significantly reduce complications and improve patient outcomes.