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Blunt Cerebrovascular Injury

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Blunt cerebrovascular injuries: redefining screening criteria in the era of noninvasive diagnosis.
Burlew CC, Biffl WL, Moore EE, Barnett CC, Johnson JL, Bensard DD.
J Trauma Acute Care Surg. 2012 Feb;72(2):330-5; discussion 336-7, quiz 539.

Rationale for inclusion: 20% of BCVI patients had no conventional screening criteria, leading the authors to consider expanding screening criteria to mandible fractures, complex skull fractures, TBI with thoracic injury, scalp degloving, and thoracic vascular injuries.

Citations - 50 (as of July 2017)

Improving the screening criteria for blunt cerebrovascular injury: the appropriate role for computed tomography angiography.
Emmett KP, Fabian TC, DiCocco JM, Zarzaur BL, Croce MA.
J Trauma. 2011 May;70(5):1058-63; discussion 1063-5.

Rationale for inclusion: 16% of patients in this BCVI series had no conventional screening criteria, advocating for more aggressive screening measures.

Citations - 42 (as of July 2017)

Optimal outcomes for patients with blunt cerebrovascular injury (BCVI): tailoring treatment to the lesion.
DiCocco JM, Fabian TC, Emmett KP, Magnotti LJ, Zarzaur BL, Bate BG, Muhlbauer MS, Khan N, Kelly JM, Williams JS, Croce MA.
J Am Coll Surg. 2011 Apr;212(4):549-57; discussion 557-9.

Rationale for inclusion: Endovascular treatment of pseudo-aneurysms, dissections, and fistulas led to outcomes similar to medical treatment.

Citations - 35 (as of July 2017)

CTA-based screening reduces time to diagnosis and stroke rate in blunt cervical vascular injury.
Eastman AL, Muraliraj V, Sperry JL, Minei JP.
J Trauma. 2009 Sep;67(3):551-6; discussion 555-6.

Rationale for inclusion: Time to diagnosis and overall stroke rate was reduced when CT angiography replaced conventional angiography for BCVI screening.

Citations - 74 (as of July 2017)

Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents.
Cothren CC, Biffl WL, Moore EE, Kashuk JL, Johnson JL.
Arch Surg. 2009 Jul;144(7):685-90.

Rationale for inclusion: While early treatment of BCVI before the onset of symptoms nearly eliminated stroke risk in this large series, type of therapy did not seem to influence either stroke risk or healing.

Citations - 89 (as of July 2017)

Antithrombotic therapy and endovascular stents are effective treatment for blunt carotid injuries: results from longterm followup.
Edwards NM, Fabian TC, Claridge JA, Timmons SD, Fischer PE, Croce MA.
J Am Coll Surg. 2007 May;204(5):1007-13; discussion 1014-5.

Rationale for inclusion: Retrospective study correlated long-term outcomes with type of antithrombotic therapy found both anti-platelet therapy and anticoagulation effective at preventing long-term sequelae.  

Citations - 99 (as of July 2017)

Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate.
Cothren CC, Moore EE, Biffl WL, Ciesla DJ, Ray CE Jr, Johnson JL, Moore JB, Burch JM.
Arch Surg. 2004 May;139(5):540-5; discussion 545-6.

Rationale for inclusion: Early angiographic screening and treatment reduces stroke risk in BCVI.  

CAVEAT: The best anticoagulant in this setting was not established.

Citations - 194 (as of July 2017)

Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes.
Miller PR, Fabian TC, Croce MA, Cagiannos C, Williams JS, Vang M, Qaisi WG, Felker RE, Timmons SD.
Ann Surg. 2002 Sep;236(3):386-93; discussion 393-5.

Rationale for inclusion: Aggressive screening detected BCVI in 1% of blunt trauma admissions.  The authors found CTA and MRA to be inadequate for BCVI screening.

Citations - 370 (as of July 2017)

Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography.
Biffl WL, Ray CE Jr, Moore EE, Franciose RJ, Aly S, Heyrosa MG, Johnson JL, Burch JM.
Ann Surg. 2002 May;235(5):699-706; discussion 706-7.

Rationale for inclusion: Prospective assessment of routine follow-up angiography in BCVI, finding that many will require a change in management based on new imaging.

Citations - 266 (as of July 2017)

Blunt cerebrovascular injuries: diagnosis and treatment.
Miller PR, Fabian TC, Bee TK, Timmons S, Chamsuddin A, Finkle R, Croce MA.
J Trauma. 2001 Aug;51(2):279-85; discussion 285-6.

Rationale for inclusion: Aggressive screening and treatment led to significant reductions in stroke rates for both carotid and vertebral BCVI.

Citations - 246 (as of July 2017)

Blunt carotid arterial injuries: implications of a new grading scale.
Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Burch JM.
J Trauma. 1999 Nov;47(5):845-53.

Rationale for inclusion: Described BCVI grading system (I-V) that is still commonly used today.

Citations - 330 (as of July 2017)

Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy.
Fabian TC, Patton JH Jr, Croce MA, Minard G, Kudsk KA, Pritchard FE.
Ann Surg. 1996 May;223(5):513-22; discussion 522-5.

Rationale for inclusion: Established a clear role for the use of anticoagulation in the management of BCVI.  Heparin was independently associated with improvements in neurologic outcome and survival.

Citations - 457 (as of July 2017)

The spectrum of blunt injury to the carotid artery: a multicenter perspective.
Cogbill TH, Moore EE, Meissner M, Fischer RP, Hoyt DB, Morris JA, Shackford SR, Wallace JR, Ross SE, Ochsner MG, et al.
J Trauma. 1994 Sep;37(3):473-9.

Rationale for inclusion: Multi-center description of BCVI clinical characteristics and outcomes based on management.

Citations - 298 (as of July 2017)

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