Factors associated with stroke formation in blunt cerebrovascular injury: An EAST multicenter study

Emily C. Esposito, Joseph A. Kufera, Timothy W. Wolff, M. Chance Spalding, Joshua Simpson, Julie A. Dunn, Linda Zier, Sigrid Burruss, Paul Kim, Lewis E. Jacobson, Jamie Williams, Jeffry Nahmias, Areg Grigorian, Laura Harmon, Anna Gergen, Matthew Chatoor, Rishi Rattan, Andrew J. Young, Jose L. Pascual, Jason MurryAdrian W. Ong, Alison Muller, Rovinder S. Sandhu, Rachel Appelbaum, Nikolay Bugaev, Antony Tatar, Khaled Zreik, Leah Hustad, Mark J. Lieser, Deborah M. Stein, Thomas M. Scalea, Margaret H. Lauerman

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)347-354
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume92
Issue number2
DOIs
StatePublished - Feb 1 2022
Externally publishedYes

Keywords

  • Blunt cerebrovascular injury
  • Internal carotid artery injury
  • Vertebral artery injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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