TY - JOUR
T1 - Factors associated with stroke formation in blunt cerebrovascular injury
T2 - An EAST multicenter study
AU - Esposito, Emily C.
AU - Kufera, Joseph A.
AU - Wolff, Timothy W.
AU - Chance Spalding, M.
AU - Simpson, Joshua
AU - Dunn, Julie A.
AU - Zier, Linda
AU - Burruss, Sigrid
AU - Kim, Paul
AU - Jacobson, Lewis E.
AU - Williams, Jamie
AU - Nahmias, Jeffry
AU - Grigorian, Areg
AU - Harmon, Laura
AU - Gergen, Anna
AU - Chatoor, Matthew
AU - Rattan, Rishi
AU - Young, Andrew J.
AU - Pascual, Jose L.
AU - Murry, Jason
AU - Ong, Adrian W.
AU - Muller, Alison
AU - Sandhu, Rovinder S.
AU - Appelbaum, Rachel
AU - Bugaev, Nikolay
AU - Tatar, Antony
AU - Zreik, Khaled
AU - Hustad, Leah
AU - Lieser, Mark J.
AU - Stein, Deborah M.
AU - Scalea, Thomas M.
AU - Lauerman, Margaret H.
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - BACKGROUND: Stroke risk factors after blunt cerebrovascular injury (BCVI) are ill-defined.We hypothesized that factors associatedwith stroke for BCVI would include medical therapy (i.e., Aspirin), radiographic features, and protocolization of care. METHODS: An Eastern Association for the Surgery of Trauma-sponsored, 16-center, prospective, observational trial was undertaken. Stroke risk factors were analyzed individually for vertebral artery (VA) and internal carotid artery (ICA) BCVI. Blunt cerebrovascular injuries were graded on the standard 1 to 5 scale. Data were from the initial hospitalization only. RESULTS: Seven hundred seventy-seven BCVIs were included. Stroke rate was 8.9% for all BCVIs, with an 11.7% rate of stroke for ICA BCVI and a 6.7% rate for VA BCVI. Use of a management protocol ( p = 0.01), management by the trauma service ( p = 0.04), antiplatelet therapy over the hospital stay ( p < 0.001), and Aspirin therapy specifically over the hospital stay ( p < 0.001) weremore common in ICA BCVI without stroke compared with those with stroke. Antiplatelet therapy over the hospital stay ( p < 0.001) and Aspirin therapy over the hospital stay ( p < 0.001) were more common in VA BCVI without stroke than with stroke. Percentage luminal stenosis was higher in both ICA BCVI ( p = 0.002) and VA BCVI ( p < 0.001) with stroke. Decrease in percentage luminal stenosis ( p < 0.001), resolution of intraluminal thrombus ( p = 0.003), and new intraluminal thrombus ( p = 0.001) weremore common in ICA BCVI with stroke than without, while resolution of intraluminal thrombus ( p = 0.03) and new intraluminal thrombus ( p = 0.01) were more common in VA BCVI with stroke than without. CONCLUSION: Protocol-driven management by the trauma service, antiplatelet therapy (specifically Aspirin), and lower percentage luminal stenosis were associatedwith lower stroke rates,while resolution and development of intraluminal thrombuswere associated with higher stroke rates. Further research will be needed to incorporate these risk factors into lesion specific BCVI management.
AB - BACKGROUND: Stroke risk factors after blunt cerebrovascular injury (BCVI) are ill-defined.We hypothesized that factors associatedwith stroke for BCVI would include medical therapy (i.e., Aspirin), radiographic features, and protocolization of care. METHODS: An Eastern Association for the Surgery of Trauma-sponsored, 16-center, prospective, observational trial was undertaken. Stroke risk factors were analyzed individually for vertebral artery (VA) and internal carotid artery (ICA) BCVI. Blunt cerebrovascular injuries were graded on the standard 1 to 5 scale. Data were from the initial hospitalization only. RESULTS: Seven hundred seventy-seven BCVIs were included. Stroke rate was 8.9% for all BCVIs, with an 11.7% rate of stroke for ICA BCVI and a 6.7% rate for VA BCVI. Use of a management protocol ( p = 0.01), management by the trauma service ( p = 0.04), antiplatelet therapy over the hospital stay ( p < 0.001), and Aspirin therapy specifically over the hospital stay ( p < 0.001) weremore common in ICA BCVI without stroke compared with those with stroke. Antiplatelet therapy over the hospital stay ( p < 0.001) and Aspirin therapy over the hospital stay ( p < 0.001) were more common in VA BCVI without stroke than with stroke. Percentage luminal stenosis was higher in both ICA BCVI ( p = 0.002) and VA BCVI ( p < 0.001) with stroke. Decrease in percentage luminal stenosis ( p < 0.001), resolution of intraluminal thrombus ( p = 0.003), and new intraluminal thrombus ( p = 0.001) weremore common in ICA BCVI with stroke than without, while resolution of intraluminal thrombus ( p = 0.03) and new intraluminal thrombus ( p = 0.01) were more common in VA BCVI with stroke than without. CONCLUSION: Protocol-driven management by the trauma service, antiplatelet therapy (specifically Aspirin), and lower percentage luminal stenosis were associatedwith lower stroke rates,while resolution and development of intraluminal thrombuswere associated with higher stroke rates. Further research will be needed to incorporate these risk factors into lesion specific BCVI management.
KW - Blunt cerebrovascular injury
KW - Internal carotid artery injury
KW - Vertebral artery injury
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U2 - 10.1097/TA.0000000000003455
DO - 10.1097/TA.0000000000003455
M3 - Article
C2 - 34739003
AN - SCOPUS:85123879020
VL - 92
SP - 347
EP - 354
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 2
ER -