Cothren C Clay, Moore Ernest E, Biffl Walter L, Ciesla David J, Ray Charles E, Johnson Jeffrey L, Moore John B, Burch Jon M
Department of Surgery, Denver Health Medical Center and the University of Colorado Health Sciences Center, 80204, USA.
Arch Surg. 2004 May;139(5):540-5; discussion 545-6. doi: 10.1001/archsurg.139.5.540.
Aggressive screening, early angiographic diagnosis, and prompt anticoagulation for blunt carotid artery injuries (CAIs) improves neurologic outcome.
From January 1, 1996, through December 31, 2002, there were 13 280 blunt trauma admissions to our level I center, of which 643 underwent screening angiography for blunt CAI on the basis of a protocol including injury patterns and symptoms. Patients without contraindications underwent anticoagulation immediately for documented lesions.
A state-designated, level I urban trauma center.
Of the 643 patients undergoing screening angiography, 114 (18%) had confirmed CAI.
Early angiographic diagnosis and prompt anticoagulation.
Diagnosis, stroke rate, and complications stratified by method of intervention.
A CAI was identified in 114 patients during the 7-year study period; the majority were men (71%), with a mean +/- SD age of 34 +/- 1.3 years and a mean +/- SD Injury Severity Score of 29 +/- 1.5. Seventy-three patients underwent anticoagulation after diagnosis (heparin in 54, low-molecular-weight heparin in 2, antiplatelet agents in 17); none had a stroke. Of the 41 patients who did not receive anticoagulation (because of a contraindication in 27, symptoms before diagnosis in 9, and carotid coil or stent in 5), 19 patients (46%) developed neurologic ischemia. Ischemic neurologic events occurred in 100% of patients who presented with symptoms before angiographic diagnosis and those receiving a carotid coil or stent without anticoagulation.
Our prospective evaluation of blunt CAIs suggests that early diagnosis and prompt anticoagulation reduce ischemic neurologic events and their disability. The optimal anticoagulation regimen, however, remains to be established.
积极筛查、早期血管造影诊断以及对钝性颈动脉损伤（CAI）迅速进行抗凝治疗可改善神经功能预后。
从1996年1月1日至2002年12月31日，共有13280例钝性创伤患者入住我们的一级中心，其中643例根据包括损伤类型和症状的方案接受了钝性CAI的筛查血管造影。无禁忌证的患者对确诊病变立即进行抗凝治疗。
一家州指定的一级城市创伤中心。
在643例接受筛查血管造影的患者中，114例（18%）确诊为CAI。
早期血管造影诊断和迅速抗凝治疗。
按干预方法分层的诊断、卒中发生率和并发症。
在7年的研究期间，114例患者确诊为CAI；大多数为男性（71%），平均年龄±标准差为34±1.3岁，平均损伤严重程度评分±标准差为29±1.5。73例患者在诊断后接受了抗凝治疗（54例使用肝素，2例使用低分子肝素，17例使用抗血小板药物）；无一例发生卒中。在41例未接受抗凝治疗的患者中（27例因禁忌证，9例在诊断前出现症状，5例使用颈动脉线圈或支架），19例（46%）发生神经缺血。在血管造影诊断前出现症状的患者以及接受颈动脉线圈或支架但未抗凝的患者中，缺血性神经事件的发生率为100%。
我们对钝性CAI的前瞻性评估表明，早期诊断和迅速抗凝可减少缺血性神经事件及其导致的残疾。然而，最佳抗凝方案仍有待确定。
