Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
Can J Neurol Sci. 2010 Sep;37(5):574-9. doi: 10.1017/s0317167100010726.
Blunt cerebrovascular injury (BCVI) to the carotid and vertebral arteries is a potentially devastating injury in trauma patients. The optimal management for BCVI has not been standardized. At our institution, 64-slice multi-detector computed tomographic angiography (CTA) has been used as the initial screening exam for BCVI in patients who met predefined screening criteria. The purpose of this study is to review the incidence of CTA-diagnosed BCVI in at-risk patients and to evaluate the treatment and clinical outcome of patients with BCVI.
This study included trauma patients with a positive diagnosis of BCVI on CTA during a 41-month study period. The medical records and relevant radiographic findings were retrospectively reviewed.
Twenty seven of 222 blunt trauma patients evaluated with CTA had a positive diagnosis of BCVI, with an occurrence rate of 12.2%. Traumatic brain injury (72.2%) and basal skull fractures (55.6%) were the most frequent associated injuries with carotid trauma while 100% of blunt vertebral injuries occurred in the setting of cervical fractures. Fourteen (51.8%) patients received medical therapy; Eleven (40.7%) patients received conservative treatment. Endovascular treatment was attempted in a single case of vertebral arteriovenous fistula. BCVI-related stroke was found in four patients (14.8%), one of whom developed an infarct while on medical treatment.
BCVI is found in a significant portion of blunt trauma patients with identifiable risk factors, and screening CTA has high diagnostic yield in detecting these lesions. Medical therapy is the mainstay of treatment at our institution; however, BCVI-related stroke may occur despite treatment.
钝性颅脑血管损伤（BCVI）是创伤患者潜在的破坏性损伤，颈动脉和椎动脉均可受累。BCVI 的最佳治疗方法尚未标准化。在我们的机构中，64 排多层 CT 血管造影（CTA）已被用作符合预设筛选标准的患者的 BCVI 初始筛选检查。本研究的目的是回顾高危患者 CTA 诊断的 BCVI 的发生率，并评估 BCVI 患者的治疗和临床转归。
本研究纳入了在 41 个月的研究期间 CTA 阳性诊断为 BCVI 的创伤患者。回顾性分析了病历和相关影像学发现。
222 例接受 CTA 评估的钝性创伤患者中有 27 例被诊断为 BCVI，发生率为 12.2%。创伤性脑损伤（72.2%）和颅底骨折（55.6%）是最常见的与颈动脉损伤相关的损伤，而 100%的钝性颈椎骨折合并有椎骨损伤。14 例（51.8%）患者接受了药物治疗；11 例（40.7%）患者接受了保守治疗。在 1 例椎动脉动静脉瘘患者中尝试了血管内治疗。4 例（14.8%）患者发生了与 BCVI 相关的卒中，其中 1 例在药物治疗时发生了梗死。
在有明确危险因素的钝性创伤患者中，BCVI 的发生率较高，且 CTA 筛查对这些病变具有较高的诊断率。药物治疗是我们机构的主要治疗方法；然而，尽管进行了治疗，仍可能发生与 BCVI 相关的卒中。
