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The role of number of affected vessels on radiologic and clinical outcomes of patients with blunt cerebrovascular injury.
Hosseinpour, Hamidreza; Magnotti, Louis J; Huang, Dih-Dih; Weinberg, Jordan A; Tang, Andrew; Hejazi, Omar; Stewart, Collin; Bhogadi, Sai Krishna; Anand, Tanya; Joseph, Bellal.
Afiliación
  • Hosseinpour H; Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ.
  • Magnotti LJ; Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ.
  • Huang DD; Department of Surgery, Creighton University School of Medicine, Phoenix Regional Campus, St Joseph's Hospital Medical Center, Phoenix, AZ.
  • Weinberg JA; Department of Surgery, Creighton University School of Medicine, Phoenix Regional Campus, St Joseph's Hospital Medical Center, Phoenix, AZ.
  • Tang A; Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ.
  • Hejazi O; Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ.
  • Stewart C; Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ.
  • Bhogadi SK; Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ.
  • Anand T; Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ.
  • Joseph B; Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ. Electronic address: bjoseph@arizona.edu.
J Vasc Surg ; 80(3): 685-692, 2024 Sep.
Article en En | MEDLINE | ID: mdl-38677659
ABSTRACT

OBJECTIVE:

There is a lack of data on the role of characteristics of injured vessels on the outcomes of patients with blunt cerebrovascular injuries (BCVIs). The aim of this study was to assess the effect of the number (single vs multiple) of injured vessels on outcomes.

METHODS:

This is a retrospective study at two American College of Surgeons Level I trauma centers (2017-2021). Adult (>16 years) trauma patients with BCVIs are included. Injuries were graded by the Denver Scale based on the initial computed tomography angiography (CTA). Early repeat CTA was performed 7 to 10 days after diagnosis. Patients were stratified by the number (single vs multiple) of the involved vessels. Outcomes included progression of BCVIs on repeat CTA, stroke, and in-hospital mortality attributable to BCVIs. Multivariable regression analyses were performed to identify the association between the number of injured vessels and outcomes.

RESULTS:

A total of 491 patients with 591 injured vessels (285 carotid and 306 vertebral arteries) were identified. Sixty percent were male, the mean age was 44 years, and the median Injury Severity Score was 18 (interquartile range, 11-25). Overall, 18% had multiple-vessel injuries, 16% had bilateral vessel injuries, and 3% had multiple injuries on the same side. The overall rates of progression to higher-grade injuries, stroke, and mortality were 23%, 7.7%, and 8.8%, respectively. On uni- and multivariable analyses, multiple BCVIs were associated with progression to higher-grade injuries on repeat imaging, stroke, and mortality compared with single-vessel injuries.

CONCLUSIONS:

BCVIs with multiple injured vessels are more likely to progress to higher grades on repeat CTA, with multiple injuries independently associated with worse clinical outcomes, compared with those with single injuries. These findings highlight the importance of incorporating the number of injured vessels in clinical decision-making and in defining protocols for repeat imaging.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Heridas no Penetrantes / Mortalidad Hospitalaria / Traumatismos Cerebrovasculares / Angiografía por Tomografía Computarizada Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: J Vasc Surg Asunto de la revista: ANGIOLOGIA Año: 2024 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Heridas no Penetrantes / Mortalidad Hospitalaria / Traumatismos Cerebrovasculares / Angiografía por Tomografía Computarizada Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: J Vasc Surg Asunto de la revista: ANGIOLOGIA Año: 2024 Tipo del documento: Article