R Adams Cowley Shock Trauma Center at University of Maryland School of Medicine, Baltimore, MD, USA.
Grant Medical Center, Columbus, OH, USA.
Am Surg. 2023 Jun;89(6):2618-2627. doi: 10.1177/00031348221082277. Epub 2022 Jun 1.
Higher blunt cerebrovascular injury (BCVI) grade and lack of medical therapy are associated with stroke. Knowledge of stroke risk factors specific to individual grades may help tailor BCVI therapy to specific injury characteristics.
A post-hoc analysis of a 16 center, prospective, observational trial (2018-2020) was performed including grade 1 internal carotid artery (ICA) BCVI. Repeat imaging was considered the second imaging occurrence only.
From 145 grade 1 ICA BCVI included, 8 (5.5%) suffered a stroke. Grade 1 ICA BCVI with stroke were more commonly treated with mixed anticoagulation and antiplatelet therapy (75.0% vs 9.6%, P <.001) and less commonly antiplatelet therapy (25.0% vs 82.5%, P = .001) compared to injuries without stroke. Of the 8 grade 1 ICA BCVI with stroke, 4 (50.0%) had stroke after medical therapy was started. In comparing injuries with resolution at repeat imaging to those without, stroke occurred in 7 (15.9%) injuries without resolution and 0 (0%) injuries with resolution (P = .005). At repeat imaging in grade 1 ICA BCVI with stroke, grade of injury was grade 1 in 2 injuries, grade 2 in 3 injuries, grade 3 in 1 injury, and grade 5 in one injury.
While the stroke rate for grade 1 ICA BCVI is low overall, injury persistence appears to heighten stroke risk. Some strokes occurred despite initiation of medical therapy. Repeat imaging is needed in grade 1 ICA BCVI to evaluate for injury progression or resolution.
较高的钝性脑血管损伤（BCVI）分级和缺乏药物治疗与中风有关。了解针对特定分级的中风风险因素可能有助于根据特定损伤特征调整 BCVI 治疗方法。
对一项 16 中心、前瞻性、观察性试验（2018-2020 年）进行了事后分析，其中包括 1 级颈内动脉（ICA）BCVI。重复成像仅被视为第二次成像事件。
在纳入的 145 例 1 级 ICA BCVI 中，有 8 例（5.5%）发生中风。与未发生中风的损伤相比，1 级 ICA BCVI 伴中风者更常接受混合抗凝和抗血小板治疗（75.0% vs 9.6%，P<.001），而较少接受抗血小板治疗（25.0% vs 82.5%，P=.001）。在 8 例 1 级 ICA BCVI 伴中风中，有 4 例（50.0%）在开始药物治疗后发生中风。在比较重复成像有缓解的损伤与无缓解的损伤时，无缓解的损伤中有 7 例（15.9%）发生中风，而有缓解的损伤中无 1 例发生中风（P=.005）。在 1 级 ICA BCVI 伴中风的重复成像中，2 例损伤分级为 1 级，3 例为 2 级，1 例为 3 级，1 例为 5 级。
尽管 1 级 ICA BCVI 的中风发生率总体较低，但损伤持续存在似乎会增加中风风险。尽管已经开始了药物治疗，但仍有一些中风发生。在 1 级 ICA BCVI 中需要重复成像以评估损伤进展或缓解情况。
