Should CT angiography of the supra-aortic arteries be performed systematically following attempted suicide by hanging?

ABSTRACT

PURPOSE: Characterize and determine the frequency of dissections of the supra-aortic arteries (SAA) and injuries to the cervical spine and pharyngolaryngeal cartilages viewed on CT scans after an attempted suicide by hanging. MATERIALS AND METHODS: A retrospective, single-centre study of all patients admitted for attempted suicide by hanging between January 2010 and June 2017 who received CT angiography of the SAA. Search for signs of dissection of the cervical arteries and injuries to the brain, spinal column and pharyngeal and laryngeal cartilages. The results were compared with the initial clinical severity, which was assessed indirectly by whether patients were initially admitted in an intensive care unit (ICU) or in an emergency department (ED). RESULTS: Out of 162 patients included, 4 presented with SAA dissection (2.5%), comprising 3 vertebral arteries and 1 external carotid artery. The cases in question were of 4 men, all in cardiac arrest on arrival and all were treated in ICU. Of the most serious cases, 18/72 (25%) had anoxia-related injuries and one also presented with a C2 fracture. No vascular lesions or signs of cerebral anoxia were observed in the 90 ED patients. Nevertheless, pharyngeal and laryngeal fractures were observed in both groups, with no significant difference. CONCLUSION: In our study, 2.5% of CT angiograms performed after an attempted hanging revealed SAA dissection. Crucially, only most severe patients, who have been immediately admitted to ICU suffered SAA. These results call into question the systematic indication of this exam in cases of hanging attempts.