Natural history and nonoperative management of penetrating cerebrovascular injury. Issue 1 (January 2023)

• Record Type: Journal Article
• Authors: Witt, Cordelie E.; Sumislawski, Joshua J.; Burlew, Clay Cothren
• Is Part Of: Injury. Volume 54:Issue 1(2023)
• Page Start: 131
• Page End: 137
• Publication Date: 2023-01
• Subjects: Penetrating cerebrovascular injury -- Stroke, antithrombotic therapy -- Nonoperative management; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2022.10.030
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Of 14 patients with nonoperatively managed PCVI, none required delayed operation. 3 strokes occurred, usually prior to antithrombotic treatment. PCVIs are at risk for progression: we suggest early treatment and serial CTAs. Abstract: Introduction: There is a modern precedent for nonoperative management of select penetrating cerebrovascular injuries (PCVIs); however, there is minimal data to guide management. Patients and methods: This study assessed treatments, radiographic injury progression, and outcomes for all patients with PCVIs managed at an urban Level I trauma center from 2016 to 2021 that underwent initial nonoperative management (NOM). Results: Fourteen patients were included. There were 11, 635 trauma admissions, 378 patients with blunt cerebrovascular injury, and 18 patients with operatively-managed PCVI during this timeframe. All patients received antithrombotic therapy, but this was delayed in some due to concomitant injuries. Three patients had stroke (21%): two before antithrombotic initiation, and one with unclear timing relative to treatment. Three patients underwent endovascular interventions. On follow-up imaging, 14% had injury resolution, 36% were stable, 21% worsened, and 29% had no follow-up vascular imaging. One patient died (7%), one had a bleeding complication (7%), and no patient required delayed operative intervention. Discussion: Early initiation of antithrombotic therapy, early surveillance imaging, and selective use of endovascular interventions are important for nonoperative management of PCVI.