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Grade 1 Internal Carotid Artery Blunt Cerebrovascular Injury Persistence Risks Stroke With Current Management: An EAST Multicenter Study.
Yang, Sarah; Esposito, Emily; Spalding, Chance; Simpson, Joshua; Dunn, Julie A; Zier, Linda; Burruss, Sigrid; Kim, Paul; Jacobson, Lewis E; Williams, Jamie; Nahmias, Jeffry; Grigorian, Areg; Harmon, Laura; Gergen, Anna; Chatoor, Matthew; Rattan, Rishi; Young, Andrew J; Pascual, Jose L; Murry, Jason; Ong, Adrian W; Muller, Alison; Sandhu, Rovinder S; Appelbaum, Rachel; Bugaev, Nikolay; Tatar, Antony; Zreik, Khaled; Lieser, Mark J; Scalea, Thomas M; Stein, Deborah M; Lauerman, Margaret.
Affiliation
  • Yang S; R Adams Cowley Shock Trauma Center at University of Maryland School of Medicine, Baltimore, MD, USA.
  • Esposito E; R Adams Cowley Shock Trauma Center at University of Maryland School of Medicine, Baltimore, MD, USA.
  • Spalding C; Grant Medical Center, Columbus, OH, USA.
  • Simpson J; Prisma Health, Greeneville, SC, USA.
  • Dunn JA; University of Colorado, Loveland, CO, USA.
  • Zier L; University of Colorado, Loveland, CO, USA.
  • Burruss S; Loma Linda University, Loma Linda, CA, USA.
  • Kim P; Loma Linda University, Loma Linda, CA, USA.
  • Jacobson LE; Ascension Health, Indianapolis, IN, USA.
  • Williams J; Ascension Health, Indianapolis, IN, USA.
  • Nahmias J; University of California, Irvine, Irvine, CA, USA.
  • Grigorian A; University of California, Irvine, Irvine, CA, USA.
  • Harmon L; University of Colorado, Denver, CO, USA.
  • Gergen A; University of Colorado, Denver, CO, USA.
  • Chatoor M; University of Miami, Miami, FL, USA.
  • Rattan R; University of Miami, Miami, FL, USA.
  • Young AJ; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
  • Pascual JL; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
  • Murry J; UT Health Tyler, Tyler, TX, USA.
  • Ong AW; Towerhealth, Reading, PA, USA.
  • Muller A; Towerhealth, Reading, PA, USA.
  • Sandhu RS; Lehigh Valley Health Network, Allentown, PA, USA.
  • Appelbaum R; Lehigh Valley Health Network, Allentown, PA, USA.
  • Bugaev N; Tufts University School of Medicine, Boston, MA, USA.
  • Tatar A; Tufts University School of Medicine, Boston, MA, USA.
  • Zreik K; Sanford Health, Fargo, ND, USA.
  • Lieser MJ; Research Medical Center, Kansas City, MO, USA.
  • Scalea TM; R Adams Cowley Shock Trauma Center at University of Maryland School of Medicine, Baltimore, MD, USA.
  • Stein DM; R Adams Cowley Shock Trauma Center at University of Maryland School of Medicine, Baltimore, MD, USA.
  • Lauerman M; R Adams Cowley Shock Trauma Center at University of Maryland School of Medicine, Baltimore, MD, USA.
Am Surg ; 89(6): 2618-2627, 2023 Jun.
Article in En | MEDLINE | ID: mdl-35652129
ABSTRACT

BACKGROUND:

Higher blunt cerebrovascular injury (BCVI) grade and lack of medical therapy are associated with stroke. Knowledge of stroke risk factors specific to individual grades may help tailor BCVI therapy to specific injury characteristics.

METHODS:

A post-hoc analysis of a 16 center, prospective, observational trial (2018-2020) was performed including grade 1 internal carotid artery (ICA) BCVI. Repeat imaging was considered the second imaging occurrence only.

RESULTS:

From 145 grade 1 ICA BCVI included, 8 (5.5%) suffered a stroke. Grade 1 ICA BCVI with stroke were more commonly treated with mixed anticoagulation and antiplatelet therapy (75.0% vs 9.6%, P <.001) and less commonly antiplatelet therapy (25.0% vs 82.5%, P = .001) compared to injuries without stroke. Of the 8 grade 1 ICA BCVI with stroke, 4 (50.0%) had stroke after medical therapy was started. In comparing injuries with resolution at repeat imaging to those without, stroke occurred in 7 (15.9%) injuries without resolution and 0 (0%) injuries with resolution (P = .005). At repeat imaging in grade 1 ICA BCVI with stroke, grade of injury was grade 1 in 2 injuries, grade 2 in 3 injuries, grade 3 in 1 injury, and grade 5 in one injury.

DISCUSSION:

While the stroke rate for grade 1 ICA BCVI is low overall, injury persistence appears to heighten stroke risk. Some strokes occurred despite initiation of medical therapy. Repeat imaging is needed in grade 1 ICA BCVI to evaluate for injury progression or resolution.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Carotid Artery, Internal / Carotid Artery Injuries / Stroke / Cerebrovascular Trauma Type of study: Clinical_trials / Etiology_studies / Risk_factors_studies Language: En Journal: Am Surg Year: 2023 Document type: Article Affiliation country: United States
Fulltext
Add to My VHL
Print
XML
PubMed Links
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Carotid Artery, Internal / Carotid Artery Injuries / Stroke / Cerebrovascular Trauma Type of study: Clinical_trials / Etiology_studies / Risk_factors_studies Language: En Journal: Am Surg Year: 2023 Document type: Article Affiliation country: United States