Abstract TP252: Stroke Risk After Blunt Cerebrovascular Injury With Dissection
INTRODUCTION: Blunt cerebrovascular injuries (BCVI) are common in trauma. The natural history of stroke in patients with traumatic dissection has not been well investigated. The goal of this study was to evaluate the risk of stroke with BCVI related dissection in the internal carotid (ICA) or vertebral artery (VA) territory.
METHODS: We instituted a protocol in 2007 for CTA of the head and neck in BCVI patients to look for dissection. Criteria for CTA were patients with skull base fractures, cervical spine injury, neurological deficit, or infarction on head CT. Patients with a dissection were followed clinically for development of stroke by the trauma and neurointerventional teams. A follow-up phone call was prospectively obtained at the time of data analysis for patients with confirmed dissection for interim stroke evaluation. IRB approval was obtained.
RESULTS: 51 patients were identified with an abnormal CTA for BCVI. Patients were excluded due to dissection in the external carotid (n=1), vasospasm(n=12), <1 month follow-up due to death (n=7). Of the remaining 31 patients with dissection in the analysis, the injury mechanism was: 18 MVAs, 11 falls, and 2 altercations. Location of injury was VA (n=24), ICA (n=8), and PICA (n=1). Two patients had lesions in the VA and ICA. There were 4 pseudoaneurysms (12.9%). Patients were treated with aspirin (n=27, mean 223 days); or anticoagulants (n=7, mean 114 days). Most patients (22/31, 71%) were treated with antithrombotics within 3 days of injury. One patient had a carotid stent for progressive stenosis. Mean follow-up (clinical/imaging) was 18.5+6.6 months (range 1-53 months); 19/31 (61%) patients had > 6 months follow-up. Six patients had neurological symptoms of which 3 were attributed to cervical cord injury, 1 to stroke after bypass surgery (for carotid artery avulsion), and 1 with diffuse axonal injury. One patient developed ataxia 3 days after MVC and had a cerebellar stroke. The cumulative incidence of stroke was therefore 1/31 (3.2%).
CONCLUSION: The incidence of stroke after carotid or vertebral artery dissection related to BCVI is low with good prognosis. Larger prospective studies are of interest to better define stroke risk in this population.
- © 2012 by American Heart Association, Inc.