Early repeat imaging is not warranted for high-grade blunt cerebrovascular injuries.

Abstract

The current management for blunt cerebrovascular injuries (BCVIs) includes repeat imaging 7 days to 10 days after initial diagnosis. This recommendation, however, has not been systematically evaluated. The purpose of this study was to evaluate the impact of early repeat imaging on treatment course. We hypothesized that a minority of patients with high-grade injuries (Grades III and IV) have complete resolution of their injuries early in their treatment course and hence repeat imaging does not alter their therapy. Our prospective BCVI database was queried from January 1, 1997, to January 1, 2013. Injuries were graded according to the Denver scale. Injuries, treatment, and imaging results were analyzed. BCVI healing was defined as a complete resolution of the injury. During the 16-year study, 582 patients sustained 829 BCVIs; there were 420 carotid artery injuries and 409 vertebral artery injuries. The majority (78%) received antithrombotic therapy. For the 296 carotid artery injuries (70%) with repeat imaging, there was complete healing of the injury in 56% of Grade I, 20% of Grade II, 5% of Grade III, and 0% of Grade IV injuries. For the 255 vertebral artery injuries (62%) with repeat imaging, there was a resolution of the injury in 56% of Grade I, 17% of Grade II, 14% of Grade III, and 3% of Grade IV injuries. For BCVIs overall, there was healing documented in 56% of Grade I, 18% of Grade II, 8% of Grade III, and 2% of Grade IV injuries. Injury grade of BCVIs is associated with the healing rate of the injury. While approximately half of Grade I BCVIs resolved, only 7% of all high-grade injuries healed. Early repeat imaging may not be warranted in high-grade BCVI; the vast majority of injuries do not resolve. The cost, radiation, and transport risk of early repeat imaging should be weighed against the potential treatment impact for individual patients. Therapeutic/care management study, level IV.