Abstract：
Stroke risk factors after blunt cerebrovascular injury (BCVI) are ill-defined. We hypothesized that factors associated with stroke for BCVI would include medical therapy (i.e., Aspirin), radiographic features, and protocolization of care.
An Eastern Association for the Surgery of Trauma-sponsored, 16-center, prospective, observational trial was undertaken. Stroke risk factors were analyzed individually for vertebral artery (VA) and internal carotid artery (ICA) BCVI. Blunt cerebrovascular injuries were graded on the standard 1 to 5 scale. Data were from the initial hospitalization only.
Seven hundred seventy-seven BCVIs were included. Stroke rate was 8.9% for all BCVIs, with an 11.7% rate of stroke for ICA BCVI and a 6.7% rate for VA BCVI. Use of a management protocol (p = 0.01), management by the trauma service (p = 0.04), antiplatelet therapy over the hospital stay (p < 0.001), and Aspirin therapy specifically over the hospital stay (p < 0.001) were more common in ICA BCVI without stroke compared with those with stroke. Antiplatelet therapy over the hospital stay (p < 0.001) and Aspirin therapy over the hospital stay (p < 0.001) were more common in VA BCVI without stroke than with stroke. Percentage luminal stenosis was higher in both ICA BCVI (p = 0.002) and VA BCVI (p < 0.001) with stroke. Decrease in percentage luminal stenosis (p < 0.001), resolution of intraluminal thrombus (p = 0.003), and new intraluminal thrombus (p = 0.001) were more common in ICA BCVI with stroke than without, while resolution of intraluminal thrombus (p = 0.03) and new intraluminal thrombus (p = 0.01) were more common in VA BCVI with stroke than without.
Protocol-driven management by the trauma service, antiplatelet therapy (specifically Aspirin), and lower percentage luminal stenosis were associated with lower stroke rates, while resolution and development of intraluminal thrombus were associated with higher stroke rates. Further research will be needed to incorporate these risk factors into lesion specific BCVI management.
Prognostic and Epidemiologic, Level IV.
An Eastern Association for the Surgery of Trauma-sponsored, 16-center, prospective, observational trial was undertaken. Stroke risk factors were analyzed individually for vertebral artery (VA) and internal carotid artery (ICA) BCVI. Blunt cerebrovascular injuries were graded on the standard 1 to 5 scale. Data were from the initial hospitalization only.
Seven hundred seventy-seven BCVIs were included. Stroke rate was 8.9% for all BCVIs, with an 11.7% rate of stroke for ICA BCVI and a 6.7% rate for VA BCVI. Use of a management protocol (p = 0.01), management by the trauma service (p = 0.04), antiplatelet therapy over the hospital stay (p < 0.001), and Aspirin therapy specifically over the hospital stay (p < 0.001) were more common in ICA BCVI without stroke compared with those with stroke. Antiplatelet therapy over the hospital stay (p < 0.001) and Aspirin therapy over the hospital stay (p < 0.001) were more common in VA BCVI without stroke than with stroke. Percentage luminal stenosis was higher in both ICA BCVI (p = 0.002) and VA BCVI (p < 0.001) with stroke. Decrease in percentage luminal stenosis (p < 0.001), resolution of intraluminal thrombus (p = 0.003), and new intraluminal thrombus (p = 0.001) were more common in ICA BCVI with stroke than without, while resolution of intraluminal thrombus (p = 0.03) and new intraluminal thrombus (p = 0.01) were more common in VA BCVI with stroke than without.
Protocol-driven management by the trauma service, antiplatelet therapy (specifically Aspirin), and lower percentage luminal stenosis were associated with lower stroke rates, while resolution and development of intraluminal thrombus were associated with higher stroke rates. Further research will be needed to incorporate these risk factors into lesion specific BCVI management.
Prognostic and Epidemiologic, Level IV.
摘要：
钝性脑血管损伤（BCVI）后中风的危险因素尚不明确。我们假设与BCVI中风相关的因素将包括药物治疗(即，阿司匹林),射线照相特征，和护理的原型化。
东方创伤手术协会赞助，16中心，prospective,进行了观察性试验.分别分析椎动脉（VA）和颈内动脉（ICA）BCVI的卒中危险因素。钝性脑血管损伤按标准1至5级进行分级。数据仅来自最初的住院。
包括777个BCVI。所有BCVI的卒中率为8.9%，ICABCVI的卒中发生率为11.7%，VABCVI的卒中发生率为6.7%。使用管理协议(p=0.01)，由创伤服务部门管理(p=0.04)，住院期间的抗血小板治疗（p<0.001），与有卒中患者相比,在无卒中的ICABCVI中,特别是在住院期间使用阿司匹林治疗(p<0.001)更为常见。住院期间的抗血小板治疗（p<0.001）和住院期间的阿司匹林治疗（p<0.001）在无卒中的VABCVI中比卒中更常见。卒中的ICABCVI（p=0.002）和VABCVI（p<0.001）的管腔狭窄百分比均较高。管腔狭窄百分比降低（p<0.001），管腔内血栓的分辨率（p=0.003），新的腔内血栓（p=0.001）在有卒中的ICABCVI中比没有更常见，而管腔内血栓(p=0.03)和新的管腔内血栓(p=0.01)的消退在有卒中的VABCVI中比没有卒中的情况更常见。
创伤服务的协议驱动管理，抗血小板治疗（特别是阿司匹林），较低的管腔狭窄百分比与较低的卒中发生率相关，而管腔内血栓的消退和发展与较高的卒中发生率相关。需要进一步的研究将这些危险因素纳入病变特异性BCVI管理。
预后和流行病学，四级。
东方创伤手术协会赞助，16中心，prospective,进行了观察性试验.分别分析椎动脉（VA）和颈内动脉（ICA）BCVI的卒中危险因素。钝性脑血管损伤按标准1至5级进行分级。数据仅来自最初的住院。
包括777个BCVI。所有BCVI的卒中率为8.9%，ICABCVI的卒中发生率为11.7%，VABCVI的卒中发生率为6.7%。使用管理协议(p=0.01)，由创伤服务部门管理(p=0.04)，住院期间的抗血小板治疗（p<0.001），与有卒中患者相比,在无卒中的ICABCVI中,特别是在住院期间使用阿司匹林治疗(p<0.001)更为常见。住院期间的抗血小板治疗（p<0.001）和住院期间的阿司匹林治疗（p<0.001）在无卒中的VABCVI中比卒中更常见。卒中的ICABCVI（p=0.002）和VABCVI（p<0.001）的管腔狭窄百分比均较高。管腔狭窄百分比降低（p<0.001），管腔内血栓的分辨率（p=0.003），新的腔内血栓（p=0.001）在有卒中的ICABCVI中比没有更常见，而管腔内血栓(p=0.03)和新的管腔内血栓(p=0.01)的消退在有卒中的VABCVI中比没有卒中的情况更常见。
创伤服务的协议驱动管理，抗血小板治疗（特别是阿司匹林），较低的管腔狭窄百分比与较低的卒中发生率相关，而管腔内血栓的消退和发展与较高的卒中发生率相关。需要进一步的研究将这些危险因素纳入病变特异性BCVI管理。
预后和流行病学，四级。
