管腔狭窄在动脉瘤性和非动脉瘤性钝性脑血管损伤中的影响。
Influence of luminal stenosis in aneurysmal and non-aneurysmal blunt cerebrovascular injury.
作者信息
Lauerman Margaret H, Irizarry Karen, Sliker Clint, Bruns Brandon R, Tesoriero Ronald, Scalea Thomas M, Stein Deborah M
机构信息
Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, 22 South Greene St, Baltimore, MD, 21201, USA.
出版信息
Injury. 2019 Jan;50(1):131-136. doi: 10.1016/j.injury.2018.11.003. Epub 2018 Nov 3.
BACKGROUND
Current blunt cerebrovascular injury (BCVI) grading grossly differentiates injury characteristics such as luminal stenosis (LS) and aneurysmal disease. The effect of increasing degree of LS beyond the current BCVI grading scale on stroke formation is unknown.
STUDY DESIGN
BCVI over a 3-year period were retrospectively reviewed. To investigate influence of LS beyond the BCVI grading scale within aneurysmal and non-aneurysmal BCVI, grade 2 BCVI were subdivided into BCVI with ≥ 25% and ≤ 50% LS and BCVI with > 50% and ≤ 99% LS. Grade 3 BCVI were subdivided into BCVI with pseudoaneurysm (PSA) without LS and BCVI with PSA and LS. We hypothesized increased LS beyond the current BCVI grade distinctions would be associated with higher rates of stroke formation.
RESULTS
312 BCVI were included, of which 140 were carotid BCVI and 172 vertebral BCVI. Sixteen carotid BCVI underwent endovascular intervention (EI) and 19 suffered a stroke. In carotid BCVI stroke rates increased sequentially with BCVI grade except in grade 3. There was a stroke rate of 12% in grade 1 carotid BCVI, 18% in grade 2, 6% in grade 3, and 31% in grade 4. In subgroup analysis for grade 2 carotid BCVI, BCVI with > 50% and ≤ 99% LS had higher rates of stroke (22% vs. 15%, p = 0.44) than BCVI with ≥ 25% and ≤ 50% LS. In subgroup analysis of grade 3 carotid BCVI, BCVI with PSA and LS had higher rates of stroke (9% vs. 4%, p = 0.48) than BCVI with PSA without LS. Higher rates of EI in grade 2 carotid BCVI with > 50% and ≤ 99% LS (22% vs. 5%, p = 0.14) and grade 3 carotid BCVI with PSA and LS (35% vs. 4%, p = 0.01) were noted in subgroup analysis.
CONCLUSION
Higher percentage LS beyond the currently used BCVI grading scale has a non-significantly increased rate of stroke in both aneurysmal and non-aneurysmal BCVI. Grade 3 BCVI with PSA and LS seems to be a high-risk subgroup. Use of EI confounds modern measurement of stroke risk in higher LS BCVI.
背景
目前钝性脑血管损伤（BCVI）分级对管腔狭窄（LS）和动脉瘤性疾病等损伤特征进行了大致区分。LS程度超过当前BCVI分级标准对中风形成的影响尚不清楚。
研究设计
对3年内的BCVI进行回顾性分析。为研究动脉瘤性和非动脉瘤性BCVI中超过BCVI分级标准的LS的影响，将2级BCVI细分为LS≥25%且≤50%的BCVI和LS>50%且≤99%的BCVI。3级BCVI细分为无LS的假性动脉瘤（PSA）的BCVI和有PSA及LS的BCVI。我们假设超过当前BCVI分级差异的LS增加与更高的中风形成率相关。
结果
纳入312例BCVI，其中140例为颈动脉BCVI，172例为椎动脉BCVI。16例颈动脉BCVI接受了血管内介入治疗（EI），19例发生中风。在颈动脉BCVI中，除3级外，中风率随BCVI分级依次增加。1级颈动脉BCVI的中风率为12%，2级为18%，3级为6%，4级为31%。在2级颈动脉BCVI的亚组分析中，LS>50%且≤99%的BCVI中风率（22%对15%，p = 0.44）高于LS≥25%且≤50%的BCVI。在3级颈动脉BCVI的亚组分析中，有PSA及LS的BCVI中风率（9%对4%，p = 0.48）高于无LS的PSA的BCVI。在亚组分析中，注意到LS>50%且≤99%的2级颈动脉BCVI（22%对5%，p = 0.14）和有PSA及LS的3级颈动脉BCVI（35%对4%，p = 0.01）的EI率更高。
结论
超过当前使用的BCVI分级标准的更高百分比的LS在动脉瘤性和非动脉瘤性BCVI中中风率均有非显著性增加。有PSA及LS的3级BCVI似乎是一个高危亚组。EI的使用混淆了更高LS的BCVI中中风风险的现代测量。
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