Update on Treatment of Blunt Cerebrovascular Injuries
- 2 Downloads
Purpose of Review
This article focuses on the recent practices and advancements in the treatment of blunt cerebrovascular injuries (BCVI), and also to identify areas of future study.
It remains clear that antithrombotic therapy is the mainstay of therapy for preventing BCVI-related stroke. There is no difference in the type of antithrombotic therapy used, but it is critical that treatment be initiated as early as possible post-injury. The use of endovascular stents has declined dramatically from the previous decade, and their true utility in the treatment of these injuries remains unclear. One of the biggest challenges that remains in treating BCVI is when to initiate therapy in patients with concomitant injuries that may prevent treatment early post-injury, when treatment is in fact most critical.
Antithrombotic therapy remains effective in the treatment of BCVI. The BCVI-related stroke rates reported across the literature remain stable between 5 and 10%. The treatment will most likely remain similar for the foreseeable future; however, there remain unknowns regarding the nuances of treatment that are mostly attributable to the relative rarity of the injuries.
KeywordsBCVI Blunt cerebrovascular injury Blunt carotid injury Stroke Carotid trauma
Compliance with Ethical Standards
Conflict of Interest
The authors declare no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Verneuil M. Contusions multiples deire violent hemiplegie droite signes de compression cerebrale. Paris: Bull Acad Natl Med. 1872.Google Scholar
- 8.•• Burlew CC, Sumislawski JJ, Behnfield CD, McNutt MK, McCarthy J, Sharpe JP, et al. Time to stroke: a Western Trauma Association multicenter study of blunt cerebrovascular injuries. J Trauma Acute Care Surg. 2018;85(5):858–66 This multi-institutional study identifies the time window for highest risk of BCVI-related stroke and highlights the importance of early treatment. CrossRefGoogle Scholar
- 14.• Shahan CP, Sharpe JP, Stickley SM, Manley NR, Filiberto DM, Fabian TC, et al. The changing role of endovascular stenting for blunt cerebrovascular injuries. J Trauma Acute Care Surg. 2018;84(2):308–11 This study performed at our institution relays our current practice for the use of stents in treating BCVI. CrossRefGoogle Scholar
- 16.Grandhi R, Weiner GM, Agarwal N, Panczykowski DM, Ares WJ, Rodriguez JS, et al. Limitations of multidetector computed tomography angiography for the diagnosis of blunt cerebrovascular injury. J Neurosurg. 2017;28:1–6.Google Scholar