From the University of Maryland School of Medicine (E.E., J.A.K., T.M.S., M.H.L.), Baltimore, Maryland; Ohio State University Wexner Medical Center (T.W.W., M.C.S., A.J.Y.), Columbus, Ohio; Greenville Health System (J.S.), Greenville, South Carolina; University of Colorado (J.A.D., L.Z., La.H., An.G.), Boulder, Colorado; Loma Linda University (S.B., P.K.)., Loma Linda, California; Ascension Health (L.E.J., J.W.), St. Louis, Missouri; University of California (J.N., Ar.G.), Oakland, California; University of Miami (M.C., R.R.), Miami, Florida; Perelman School of Medicine at the University of Pennsylvania (J.L.P.), Philadelphia, Pennsylvania; UT Health Tyler (J.M.), Tyler, Texas; Towerhealth (A.W.O., A.M.), West Reading, Pennsylvania; Lehigh Valley Health Network (R.S.S., R.A.), Allentown, Pennsylvania; Tufts University School of Medicine (N.B., A.T.), Boston, Massachusetts; Sanford Health (K.Z., Le.H.), Sioux Falls, South Dakota; Research Medical Center (M.J.L.), Kansas City, Missouri; University of California San Francisco (D.M.S.), San Francisco, California.
J Trauma Acute Care Surg. 2022 Feb 1;92(2):347-354. doi: 10.1097/TA.0000000000003455.
Stroke risk factors after blunt cerebrovascular injury (BCVI) are ill-defined. We hypothesized that factors associated with stroke for BCVI would include medical therapy (i.e., Aspirin), radiographic features, and protocolization of care.
An Eastern Association for the Surgery of Trauma-sponsored, 16-center, prospective, observational trial was undertaken. Stroke risk factors were analyzed individually for vertebral artery (VA) and internal carotid artery (ICA) BCVI. Blunt cerebrovascular injuries were graded on the standard 1 to 5 scale. Data were from the initial hospitalization only.
Seven hundred seventy-seven BCVIs were included. Stroke rate was 8.9% for all BCVIs, with an 11.7% rate of stroke for ICA BCVI and a 6.7% rate for VA BCVI. Use of a management protocol (p = 0.01), management by the trauma service (p = 0.04), antiplatelet therapy over the hospital stay (p < 0.001), and Aspirin therapy specifically over the hospital stay (p < 0.001) were more common in ICA BCVI without stroke compared with those with stroke. Antiplatelet therapy over the hospital stay (p < 0.001) and Aspirin therapy over the hospital stay (p < 0.001) were more common in VA BCVI without stroke than with stroke. Percentage luminal stenosis was higher in both ICA BCVI (p = 0.002) and VA BCVI (p < 0.001) with stroke. Decrease in percentage luminal stenosis (p < 0.001), resolution of intraluminal thrombus (p = 0.003), and new intraluminal thrombus (p = 0.001) were more common in ICA BCVI with stroke than without, while resolution of intraluminal thrombus (p = 0.03) and new intraluminal thrombus (p = 0.01) were more common in VA BCVI with stroke than without.
Protocol-driven management by the trauma service, antiplatelet therapy (specifically Aspirin), and lower percentage luminal stenosis were associated with lower stroke rates, while resolution and development of intraluminal thrombus were associated with higher stroke rates. Further research will be needed to incorporate these risk factors into lesion specific BCVI management.
Prognostic and Epidemiologic, Level IV.
钝性脑血管损伤（BCVI）后的中风危险因素尚不清楚。我们假设与 BCVI 中风相关的因素包括医学治疗（即阿司匹林）、影像学特征和护理方案。
东部创伤外科学会赞助的 16 个中心前瞻性观察性试验进行。单独分析椎动脉（VA）和颈内动脉（ICA）BCVI 的中风危险因素。钝性脑血管损伤按标准 1 至 5 级分级。数据仅来自初始住院期间。
纳入 777 例 BCVI。所有 BCVI 的中风发生率为 8.9%，ICA BCVI 的中风发生率为 11.7%，VA BCVI 的中风发生率为 6.7%。使用管理方案（p = 0.01）、由创伤科管理（p = 0.04）、住院期间使用抗血小板治疗（p < 0.001）和住院期间使用阿司匹林治疗（p < 0.001）更常见于 ICA BCVI 无中风者，而不是中风者。住院期间使用抗血小板治疗（p < 0.001）和住院期间使用阿司匹林治疗（p < 0.001）更常见于 VA BCVI 无中风者，而不是中风者。ICA BCVI（p = 0.002）和 VA BCVI（p < 0.001）中风者的管腔狭窄百分比均较高。ICA BCVI 中风者的管腔狭窄百分比降低（p < 0.001）、管腔内血栓溶解（p = 0.003）和新的管腔内血栓形成（p = 0.001）更为常见，而 VA BCVI 中风者的管腔内血栓溶解（p = 0.03）和新的管腔内血栓形成（p = 0.01）更为常见。
创伤科的方案驱动管理、抗血小板治疗（特别是阿司匹林）和较低的管腔狭窄百分比与较低的中风率相关，而管腔内血栓溶解和发展与较高的中风率相关。需要进一步的研究将这些危险因素纳入特定于病变的 BCVI 管理中。
预后和流行病学，IV 级。
