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The effect of circle of willis anatomy and scanning practices on outcomes for blunt cerebrovascular injuries.
Bar-Or, David; Jarvis, Stephanie; Lensing, Forrester; Bassa, David; Carrick, Matthew; Palacio Lascano, Carlos; Busch, Maxwell; Hamilton, David; Acuna, David; Greenseid, Samantha; Ojala, Daniel.
Afiliação
  • Bar-Or D; Swedish Medical Center, Englewood, CO, USA. davidbme49@gmail.com.
  • Jarvis S; Injury Outcomes Network, Colorado, , Englewood, United States. davidbme49@gmail.com.
  • Lensing F; Swedish Medical Center, Englewood, CO, USA.
  • Bassa D; Injury Outcomes Network, Colorado, , Englewood, United States.
  • Carrick M; Saint Anthony Hospital, Colorado, , Lakewood, United States.
  • Palacio Lascano C; Medical City Plano, Texas, , Plano, United States.
  • Busch M; Medical City Plano, Texas, , Plano, United States.
  • Hamilton D; South Texas Health System McAllen, Texas, , McAllen, United States.
  • Acuna D; Swedish Medical Center, Englewood, CO, USA.
  • Greenseid S; Penrose Hospital, CO, , Colorado Springs, United States.
  • Ojala D; Wesley Medical Center, Kansas, , Wichita, United States.
Scand J Trauma Resusc Emerg Med ; 32(1): 57, 2024 Jun 17.
Article em En | MEDLINE | ID: mdl-38886775
ABSTRACT

BACKGROUND:

Limited research has explored the effect of Circle of Willis (CoW) anatomy among blunt cerebrovascular injuries (BCVI) on outcomes. It remains unclear if current BCVI screening and scanning practices are sufficient in identification of concomitant COW anomalies and how they affect outcomes.

METHODS:

This retrospective cohort study included adult traumatic BCVIs at 17 level I-IV trauma centers (08/01/2017-07/31/2021). The objectives were to compare screening criteria, scanning practices, and outcomes among those with and without COW anomalies.

RESULTS:

Of 561 BCVIs, 65% were male and the median age was 48 y/o. 17% (n = 93) had a CoW anomaly. Compared to those with normal CoW anatomy, those with CoW anomalies had significantly higher rates of any strokes (10% vs. 4%, p = 0.04), ICHs (38% vs. 21%, p = 0.001), and clinically significant bleed (CSB) before antithrombotic initiation (14% vs. 3%, p < 0.0001), respectively. Compared to patients with a normal CoW, those with a CoW anomaly also had ischemic strokes more often after antithrombotic interruption (13% vs. 2%, p = 0.02).Patients with CoW anomalies were screened significantly more often because of some other head/neck indication not outlined in BCVI screening criteria than patients with normal CoW anatomy (27% vs. 18%, p = 0.04), respectively. Scans identifying CoW anomalies included both the head and neck significantly more often (53% vs. 29%, p = 0.0001) than scans identifying normal CoW anatomy, respectively.

CONCLUSIONS:

While previous studies suggested universal scanning for BCVI detection, this study found patients with BCVI and CoW anomalies had some other head/neck injury not identified as BCVI scanning criteria significantly more than patients with normal CoW which may suggest that BCVI screening across all patients with a head/neck injury may improve the simultaneous detection of CoW and BCVIs. When screening for BCVI, scans including both the head and neck are superior to a single region in detection of concomitant CoW anomalies. Worsened outcomes (strokes, ICH, and clinically significant bleeding before antithrombotic initiation) were observed for patients with CoW anomalies when compared to those with a normal CoW. Those with a CoW anomaly experienced strokes at a higher rate than patients with normal CoW anatomy specifically when antithrombotic therapy was interrupted. This emphasizes the need for stringent antithrombotic therapy regimens among patients with CoW anomalies and may suggest that patients CoW anomalies would benefit from more varying treatment, highlighting the need to include the CoW anatomy when scanning for BCVI. LEVEL OF EVIDENCE Level III, Prognostic/Epidemiological.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Ferimentos não Penetrantes / Círculo Arterial do Cérebro / Traumatismo Cerebrovascular Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Ferimentos não Penetrantes / Círculo Arterial do Cérebro / Traumatismo Cerebrovascular Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2024 Tipo de documento: Article