Scott William W, Sharp Steven, Figueroa Stephen A, Eastman Alexander L, Hatchette Charles V, Madden Christopher J, Rickert Kim L
Departments of 1 Neurosurgery.
J Neurosurg. 2015 May;122(5):1196-201. doi: 10.3171/2015.1.JNS14642. Epub 2015 Mar 20.
Proper screening, management, and follow-up of Grade 1 and 2 blunt carotid artery injuries (BCIs) remains controversial. These low-grade BCIs were analyzed to define their natural history and establish a rational management plan based on lesion progression and cerebral infarction.
A retrospective review of a prospectively maintained database of all blunt traumatic carotid and vertebral artery injuries treated between August 2003 and April 2013 was performed and Grade 1 and 2 BCIs were identified. Grade 1 injuries are defined as a vessel lumen stenosis of less than 25%, and Grade 2 injuries are defined as a stenosis of the vessel lumen between 25% and 50%. Demographic information, radiographic imaging, number of imaging sessions performed per individual, length of radiographic follow-up, radiographic outcome at end of follow-up, treatment(s) provided, and documentation of ischemic stroke or transient ischemic attack were recorded.
One hundred seventeen Grade 1 and 2 BCIs in 100 patients were identified and available for follow-up. The mean follow-up duration was 60 days. Final imaging of Grade 1 and 2 BCIs demonstrated that 64% of cases had resolved, 13% of cases were radiographically stable, and 9% were improved, whereas 14% radiographically worsened. Of the treatments received, 54% of cases were treated with acetylsalicylic acid (ASA), 31% received no treatment, and 15% received various medications and treatments, including endovascular stenting. There was 1 cerebral infarction that was thought to be related to bilateral Grade 2 BCI, which developed soon after hospital admission.
The majority of Grade 1 and 2 BCIs remained stable or improved at final follow-up. Despite a 14% rate of radiographic worsening in the Grade 1 and 2 BCIs cohort, there were no adverse clinical outcomes associated with these radiographic changes. The stroke rate was 1% in this low-grade BCIs cohort, which may be an overestimate. The use of ASA or other antiplatelet or anticoagulant medications in these low-grade BCIs did not appear to correlate with radiographic injury stability, nor with a decreased rate of cerebral infarction. Although these data suggest that these Grade 1 and 2 BCIs may require less intensive radiographic follow-up, future prospective studies are needed to make conclusive changes related to treatment and management.
对1级和2级钝性颈动脉损伤（BCI）进行恰当的筛查、处理及随访仍存在争议。对这些低级别BCI进行分析，以明确其自然病程，并根据损伤进展和脑梗死情况制定合理的处理方案。
对2003年8月至2013年4月间接受治疗的所有钝性创伤性颈动脉和椎动脉损伤的前瞻性维护数据库进行回顾性分析，确定1级和2级BCI。1级损伤定义为血管腔狭窄小于25%，2级损伤定义为血管腔狭窄在25%至50%之间。记录人口统计学信息、影像学检查结果、每人进行的影像学检查次数、影像学随访时间、随访结束时的影像学结果、所提供的治疗以及缺血性卒中或短暂性脑缺血发作的记录。
在100例患者中确定了117处1级和2级BCI并可供随访。平均随访时间为60天。1级和2级BCI的最终影像学检查显示，64%的病例已缓解，13%的病例影像学稳定，9%的病例有所改善，而14%的病例影像学恶化。在接受的治疗中，54%的病例接受了阿司匹林（ASA）治疗，31%的病例未接受治疗，15%的病例接受了包括血管内支架置入术在内的各种药物和治疗。有1例脑梗死被认为与双侧2级BCI有关，该病例在入院后不久就出现了。
在最终随访时，大多数1级和2级BCI保持稳定或有所改善。尽管1级和2级BCI队列中有14%的病例影像学恶化，但这些影像学变化并未导致不良临床后果。在这个低级别BCI队列中，卒中发生率为1%，这可能存在高估。在这些低级别BCI中使用ASA或其他抗血小板或抗凝药物似乎与影像学损伤稳定性无关，也与脑梗死发生率降低无关。尽管这些数据表明这些1级和2级BCI可能需要强度较低的影像学随访，但仍需要未来的前瞻性研究来对治疗和处理做出确定性改变。
