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Gefäßdissektion der hirnversorgenden Arterien

Sreening im Rahmen der Ganzkörpercomputertomographie

Blunt cerebrovascular injury

Screening in the context of whole body imaging of trauma patients

  • Leitthema
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Trauma und Berufskrankheit

Zusammenfassung

Die Dissektion der hirnversorgenden Gefäße infolge eines schweren Traumas ist eine diagnostisch, klinisch und therapeutisch anspruchsvolle Verletzung. Moderne, nichtinvasive, radiologische Verfahren wie die computertomographiebasierte Angiographie (CT-Angiographie, CTA) und die Magnetresonanzangiographie (MRA) ermöglichen es, diese Läsionen nachzuweisen. Der vorliegende Beitrag soll den Blick in Richtung Gefäßverletzung schärfen, eigene Erfahrungen im Rahmen der Polytraumadiagnostik aufzeichnen und eine ausgewählte Literaturübersicht geben sowie konservative (Antikoagulation) und endovaskuläre Behandlungsmöglichkeiten darstellen.

Abstract

Blunt cerebrovascular injury is an occasional but significant (diagnostically, clinically, and therapeutically) finding in multitrauma patients. These traumatic vascular lesions can be detected using modern noninvasive vascular imaging techniques such as computed tomography angiography and magnetic resonance angiography. This article emphasizes the importance of maintaining a high suspicion for unsuspected traumatic vessel lesions, describes our own experiences in imaging of trauma patients in this context, and gives an overview of the relevant literature concerning conservative (anticoagulation) and endovascular treatment options.

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Literatur

  1. Berne JD, Reuland KS, Villarreal DH et al. (2006) Sixteen-slice multi-detector computed tomographic angiography improves the accuracy of screening for blunt cerebrovascular injury. J Trauma 60: 1204–1210

    PubMed  Google Scholar 

  2. Biedermann B, Sojer M, Stocker H et al. (2007) Dissektionen der Arteria carotis interna und vertrebralis: Ursachen, Symptome, Diagnostik und Therapie. J Neurol Neurochir Psychiatr 8: 7–18

    Google Scholar 

  3. Biffl WL, Moore EE, Offner PJ et al. (1999) Blunt carotid arterial injuries: implications of a new grading scale. J Trauma 47: 845–853

    PubMed  CAS  Google Scholar 

  4. Biffl WL, Egglin T, Benedetto B et al. (2006) Sixteen-slice computed tomographic angiography is a reliable noninvasive screening test for clinically significant blunt cerebrovascular injuries. J Trauma 60: 745–752

    PubMed  Google Scholar 

  5. Bogousslavsky J, Pierre P (1992) Ischemic stroke in patients under age 45. Neurol Clin 10: 113–124

    PubMed  CAS  Google Scholar 

  6. Bub LD, Hollingworth W, Jarvik JG et al. (2005) Screening for blunt cerebrovascular injury: evaluating the accuracy of multidetector computed tomographic angiography. J Trauma 59: 691–697

    PubMed  Google Scholar 

  7. Cogbill TH, Moore EE, Meissner M et al. (1994) The spectrum of blunt injury to the carotid artery: a multicenter perspective. J Trauma 37: 473–479

    PubMed  CAS  Google Scholar 

  8. Cothren CC, Moore EE, Biffl WL et al. (2004) Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg 139: 540–546

    Article  PubMed  Google Scholar 

  9. Eastman AL, Chason DP, Perez CL et al. (2006) Computed tomographic angiography for the diagnosis of blunt cervical vascular injury: is it ready for primetime? J Trauma 60: 925–929

    PubMed  Google Scholar 

  10. Fabian TC, Patton JH, Croce MA et al. (1996) Blunt carotid injury: importance of early diagnosis and anticoagulant therapy. Ann Surg 223: 513–522

    Article  PubMed  CAS  Google Scholar 

  11. Giroud M, Fayolle H, Andre N et al. (1994) Incidence of internal carotid artery dissection in the community of Dijon. J Neurol Neurosurg Psychiatry 57: 1443

    Article  PubMed  CAS  Google Scholar 

  12. Hähnel S, Stippich C, Hartmann M et al. (2007) Kraniale und zervikale arterielle Gefäßverletzungen: Bildgebung und Therapie. Rofo Fortschr Röntgenstr 179: 119–129

    Article  Google Scholar 

  13. Houser OW, Mokri B, Sundt TM jr (1984) Spontaneous cervical cephalic arterial dissection and its residuum: angiographic spectrum. AJNR Am J Neuroradiol 5: 27–34

    PubMed  CAS  Google Scholar 

  14. Hughes KM, Collier B, Greene KA et al. (2000) Traumatic carotid artery dissection: a significant incidental finding. Am Surg 66: 1023–1027

    PubMed  CAS  Google Scholar 

  15. Malhotra AK, Camacho M, Ivatury RR et al. (2007) Computed tomographic angiography for the diagnosis of blunt carotid/vertebral artery injury: a note of caution. Ann Surg 246: 632–642

    Article  PubMed  Google Scholar 

  16. Mutze S, Rademacher G, Matthes G et al. (2005) Blunt cerebrovascular injury in patients with blunt multiple trauma: diagnostic accuracy of duplex Doppler US and early CT angiography. Radiology 237: 884–892

    Article  PubMed  Google Scholar 

  17. Schievink WI (2001) Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344: 898–906

    Article  PubMed  CAS  Google Scholar 

  18. Sliker CW, Shanmuganathan K, Mirvis SE (2008) Diagnosis of blunt cerebrovascular injuries with 16-MDCT: accuracy of whole-body MDCT compared with neck MDCT angiography. AJR Am J Roentgenol 190: 790–799

    Article  PubMed  Google Scholar 

  19. Utter GH, Hollingworth W, Hallam DK et al. (2006) Sixteen-slice CT angiography in patients with suspected blunt carotid and vertebral artery injuries. J Am Coll Surg 203: 838–848

    Article  PubMed  Google Scholar 

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Rademacher, G., Mutze, S. Gefäßdissektion der hirnversorgenden Arterien. Trauma Berufskrankh 10, 182–186 (2008). https://doi.org/10.1007/s10039-008-1430-9

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  • DOI: https://doi.org/10.1007/s10039-008-1430-9

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