Advertisement

Extracranial Cerebrovascular Trauma

  • Emily Reardon
  • J. Devin B. Watson
  • Melanie Hoehn
  • Rajabrata Sarkar
Chapter

Abstract

Injuries to the extracranial carotid and vertebral arteries continually challenge the trauma surgeons’ and vascular trauma surgeons’ clinical acumen and technical abilities. Additionally, the complexity of these injuries challenges\systems of care as often multiple specialties are involved in the expeditious and coordinated mobilization of resources. This chapter reviews the epidemiology, contemporary treatment algorithms, and management of blunt and penetrating cerebrovascular injuries both non-operative and operative strategies with open and endovascular techniques.

Keywords

Blunt cerebrovascular injury Penetrating carotid artery injury Traumatic vertebral artery injury Endovascular management of trauma 

References

  1. 1.
    Martin M, Mullenix P, Steele S, et al. Functional outcome after blunt and penetrating carotid artery injuries: analysis of the National Trauma Data Bank. J Trauma. 2005;59(4):860–4.CrossRefPubMedGoogle Scholar
  2. 2.
    Franz RW, Willette PA, Wood MJ, Wright ML, Hartman JF. A systematic review and meta-analysis of diagnostic screening criteria for blunt cerebrovascular injuries. J Am Coll Surg. 2012;214(3):313–27.  https://doi.org/10.1016/j.jamcollsurg.2011.11.012.CrossRefPubMedGoogle Scholar
  3. 3.
    Miller PR, Fabian TC, Croce MA, et al. Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg. 2002;236(3):386–393-395.  https://doi.org/10.1097/00000658-200209000-00015.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Biffl WL, Ray CE, Moore EE, et al. Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg. 2002;235(5):699–707.  https://doi.org/10.1097/00000658-200205000-00012.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Biffl WL, Cothren CC, Moore EE, et al. Western trauma association critical decisions in trauma: screening for and treatment of blunt cerebrovascular injuries. J Trauma Inj Infect Crit Care. 2009;67(6):1150–3.  https://doi.org/10.1097/TA.0b013e3181c1c1d6.CrossRefGoogle Scholar
  6. 6.
    Stein DM, Boswell S, Sliker CW, Lui FY, Scalea TM. Blunt cerebrovascular injuries: does treatment always matter? J Trauma. 2009;66(1):132–44.  https://doi.org/10.1097/TA.0b013e318142d146.CrossRefPubMedGoogle Scholar
  7. 7.
    Cothren CC, Moore EE, Ray CE, et al. Carotid artery stents for blunt cerebrovascular injury: risks exceed benefits. Arch Surg. 2005;140(5):480–5.  https://doi.org/10.1001/archsurg.140.5.480.CrossRefPubMedGoogle Scholar
  8. 8.
    Edwards NM, Fabian TC, Claridge JA, Timmons SD, Fischer PE, Croce MA. Antithrombotic therapy and endovascular stents are effective treatment for blunt carotid injuries: results from Longterm Followup. J Am Coll Surg. 2007;204(5):1007–13.  https://doi.org/10.1016/j.jamcollsurg.2006.12.041.CrossRefPubMedGoogle Scholar
  9. 9.
    Berne JD, Reuland KR, Villarreal DH, McGovern TM, Rowe SA, Norwood SH. Internal carotid artery stenting for blunt carotid artery injuries with an associated pseudoaneurysm. J Trauma. 2008;64(2):398–405.  https://doi.org/10.1097/TA.0b013e31815eb788.CrossRefPubMedGoogle Scholar
  10. 10.
    DiCocco JM, Fabian TC, Emmett KP, et al. Optimal outcomes for patients with blunt cerebrovascular injury (BCVI): tailoring treatment to the lesion. J Am Coll Surg. 2011;212(4):549–57.  https://doi.org/10.1016/j.jamcollsurg.2010.12.035.CrossRefPubMedGoogle Scholar
  11. 11.
    Bodanapally UK, Dreizin D, Sliker CW, Boscak AR, Reddy RP. Vascular injuries to the neck after penetrating trauma: diagnostic performance of 40-and 64-MDCT angiography. Am J Roentgenol. 2015;205(4):866–72.  https://doi.org/10.2214/AJR.14.14161.CrossRefGoogle Scholar
  12. 12.
    Prichayudh S, Choadrachata-Anun J, Sriussadaporn S, et al. Selective management of penetrating neck injuries using “no zone” approach. Injury. 2015;46(9):1720–5.  https://doi.org/10.1016/j.injury.2015.06.019.CrossRefPubMedGoogle Scholar
  13. 13.
    Inaba K, Aksoy H, Seamon MJ, et al. Multicenter evaluation of temporary intravascular shunt use in vascular trauma. J Trauma Acute Care Surg. 2016;80(3):359–65.  https://doi.org/10.1097/TA.0000000000000949.CrossRefPubMedGoogle Scholar
  14. 14.
    Greer LT, Kuehn RB, Gillespie DL, et al. Contemporary management of combat-related vertebral artery injuries. J Trauma Acute Care Surg. 2013;74(3):818–24.  https://doi.org/10.1097/TA.0b013e31827a08a8.CrossRefPubMedGoogle Scholar
  15. 15.
    Mwipatayi BP, Jeffery P, Beningfield SJ, Motale P, Tunnicliffe J, Navsaria PH. Management of extra-cranial vertebral artery injuries. Eur J Vasc Endovasc Surg. 2004;27(2):157–62.  https://doi.org/10.1016/j.ejvs.2003.11.008.CrossRefPubMedGoogle Scholar
  16. 16.
    Cothren CC. Treatment for blunt cerebrovascular injuries. Arch Surg. 2009;144(7):685–90.  https://doi.org/10.1001/archsurg.2009.111.CrossRefPubMedGoogle Scholar
  17. 17.
    Cothren CC. Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg. 2004;139(5):540.  https://doi.org/10.1001/archsurg.139.5.540.CrossRefPubMedGoogle Scholar
  18. 18.
    Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Burch JM. Blunt carotid arterial injuries: implications of a new grading scale. J Trauma. 1999;47(5):845–53.  https://doi.org/10.1097/00005373-199911000-00004.CrossRefPubMedGoogle Scholar
  19. 19.
    Fabian TC. Blunt cerebrovascular injuries: anatomic and pathologic heterogeneity create management enigmas. J Am Coll Surg. 2013;216(5):873–85.  https://doi.org/10.1016/j.jamcollsurg.2012.12.053.CrossRefPubMedGoogle Scholar
  20. 20.
    Eastman AL, Muraliraj V, Sperry JL, Minei JP. CTA-based screening reduces time to diagnosis and stroke rate in blunt cervical vascular injury. J Trauma. 2009;67(3):551–6.  https://doi.org/10.1097/TA.0b013e3181b84408.CrossRefPubMedGoogle Scholar
  21. 21.
    Fabian TC, Patton JH Jr, Croce MA, Minard G, Kudsk KA, Pritchard E. Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy. Ann Surg. 1996;223(5):513–25.  https://doi.org/10.1097/00000658-199605000-00007.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Bodanapally UK, Sliker CW. Imaging of blunt and penetrating Craniocervical arterial injuries. Semin Roentgenol. 2016;51(3):152–64.  https://doi.org/10.1053/j.ro.2015.12.001.CrossRefPubMedGoogle Scholar
  23. 23.
    Burlew CC, Biffl WL. Imaging for blunt carotid and vertebral artery injuries. Surg Clin North Am. 2011;91(1):217–31.  https://doi.org/10.1016/j.suc.2010.10.004.CrossRefPubMedGoogle Scholar
  24. 24.
    Eastman AL, Chason DP, Perez CL, McAnulty AL, Minei JP. Computed tomographic angiography for the diagnosis of blunt cervical vascular injury: is it ready for primetime? J Trauma. 2006;60(5):925–9. Discussion 929.  https://doi.org/10.1097/01.ta.0000197479.28714.62.CrossRefPubMedGoogle Scholar
  25. 25.
    Utter GH, Hollingworth W, Hallam DK, Jarvik JG, Jurkovich GJ. Sixteen-slice CT angiography in patients with suspected blunt carotid and vertebral artery injuries. J Am Coll Surg. 2006;203(6):838–48.  https://doi.org/10.1016/j.jamcollsurg.2006.08.003.CrossRefPubMedGoogle Scholar
  26. 26.
    Bromberg WJ, Collier BC, Diebel LN, et al. Blunt cerebrovascular injury practice management guidelines: the eastern Association for the Surgery of trauma. J Trauma. 2010;68(2):471–7.  https://doi.org/10.1097/TA.0b013e3181cb43da.CrossRefPubMedGoogle Scholar
  27. 27.
    Biffl WL, Moore EE, Offner PJ, et al. Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 1999;178(6):517–22.  https://doi.org/10.1016/S0002-9610(99)00245-7.CrossRefPubMedGoogle Scholar
  28. 28.
    Emmett KP, Fabian TC, DiCocco JM, Zarzaur BL, Croce MA. Improving the screening criteria for blunt cerebrovascular injury: the appropriate role for computed tomography angiography. J Trauma. 2011;70(5):1058–63.  https://doi.org/10.1097/TA.0b013e318213f849.CrossRefPubMedGoogle Scholar
  29. 29.
    Geddes AE, Burlew CC, Wagenaar AE, et al. Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated. Am J Surg. 2016;212(6):1167–74.  https://doi.org/10.1016/j.amjsurg.2016.09.016.CrossRefPubMedGoogle Scholar
  30. 30.
    Bruns BR, Tesoriero R, Kufera J, et al. Blunt cerebrovascular injury screening guidelines: what are we willing to miss? J Trauma Acute Care Surg. 2014;76(3):691–5.  https://doi.org/10.1097/TA.0b013e3182ab1b4d.CrossRefPubMedGoogle Scholar
  31. 31.
    Sliker CW, Mirvis SE. Imaging of blunt cerebrovascular injuries. Eur J Radiol. 2007;64(1):3–14.  https://doi.org/10.1016/j.ejrad.2007.02.015.CrossRefPubMedGoogle Scholar
  32. 32.
    McKevitt EC, Kirkpatrick AW, Vertesi L, Granger R, Simons RK. Identifying patients at risk for intracranial and extracranial blunt carotid injuries. Am J Surg. 2002;183(5):566–70.  https://doi.org/10.1016/S0002-9610(02)00845-0.CrossRefPubMedGoogle Scholar
  33. 33.
    Osborn AG. Incidence of vertebral artery thrombosis in cervical spine trauma: correlation with severity of spinal cord injury. Yearb Diagn Radiol. 2006;2006:379–81.  https://doi.org/10.1016/S0098-1672(08)70494-6.CrossRefGoogle Scholar
  34. 34.
    Laser A, Bruns BR, Kufera JA, et al. Long-term follow-up of blunt cerebrovascular injuries. J Trauma Acute Care Surg. 2016;81(6):1063–9.  https://doi.org/10.1097/TA.0000000000001223.CrossRefPubMedGoogle Scholar
  35. 35.
    Lauerman MH, Feeney T, Sliker CW, et al. Lethal now or lethal later: the natural history of grade 4 blunt cerebrovascular injury. J Trauma Acute Care Surg. 2015;78(6):1071–5.  https://doi.org/10.1097/ta.0000000000000654.CrossRefPubMedGoogle Scholar
  36. 36.
    Shahan CP, Croce MA, Fabian TC, Magnotti LJ. Impact of continuous evaluation of technology and therapy: 30 years of research reduces stroke and mortality from blunt cerebrovascular injury. J Am Coll Surg. 2017;224(4):595–9.  https://doi.org/10.1016/j.jamcollsurg.2016.12.008.CrossRefPubMedGoogle Scholar
  37. 37.
    Shahan CP, Magnotti LJ, McBeth PB, Weinberg JA, Croce MA, Fabian TC. Early antithrombotic therapy is safe and effective in patients with blunt cerebrovascular injury and solid organ injury or traumatic brain injury. J Trauma Acute Care Surg. 2016;81(1):173–7.  https://doi.org/10.1097/TA.0000000000001058.CrossRefPubMedGoogle Scholar
  38. 38.
    Burlew CC, Biffl WL, Moore EE, et al. Endovascular stenting is rarely necessary for the management of blunt cerebrovascular injuries. J Am Coll Surg. 2014;218(5):1012–7.  https://doi.org/10.1016/j.jamcollsurg.2014.01.042.CrossRefPubMedGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Emily Reardon
    • 1
  • J. Devin B. Watson
    • 2
  • Melanie Hoehn
    • 1
  • Rajabrata Sarkar
    • 1
  1. 1.Department of Surgery, Division of Vascular SurgeryUniversity of Maryland Medical CenterBaltimoreUSA
  2. 2.Department of SurgeryDavid Grant Medical CenterTravis AFBUSA

Personalised recommendations