背景:有限的研究探讨了钝性脑血管损伤(BCVI)中威利斯环(CoW)解剖结构对预后的影响。目前尚不清楚BCVI筛查和扫描方法是否足以识别伴随的COW异常以及它们如何影响结局。
方法:这项回顾性队列研究包括17个I-IV级创伤中心的成人创伤性BCVIs(2017年08月01日-2021年07月31日)。目的是比较筛查标准,扫描实践,以及有和没有COW异常的人的结果。
结果:在561个BCVI中,65%为男性,中位年龄为48岁。17%(n=93)有CoW异常。与正常CoW解剖结构相比,患有CoW异常的人发生中风的比率明显更高(10%vs.4%,p=0.04),ICHs(38%vs.21%,p=0.001),和临床显著出血(CSB)在抗血栓开始前(14%vs.3%,p<0.0001),分别。与CoW正常的患者相比,那些CoW异常的人在抗血栓治疗中断后也更容易出现缺血性中风(13%vs.2%,p=0.02)。与CoW解剖结构正常的患者相比,由于BCVI筛查标准中未概述的其他头颈部适应症,CoW异常患者的筛查频率明显更高(27%vs.18%,p=0.04),分别。识别CoW异常的扫描包括头部和颈部的频率明显更高(53%与29%,p=0.0001)比识别正常CoW解剖结构的扫描,分别。
结论:虽然以前的研究建议对BCVI检测进行通用扫描,本研究发现,与正常CoW患者相比,BCVI和CoW异常患者的其他一些未被确定为BCVI扫描标准的头颈部损伤明显多于正常CoW患者,这可能提示在所有头颈部损伤患者中进行BCVI筛查可以改善CoW和BCVIs的同时检测.筛查BCVI时,在检测伴随CoW异常方面,包括头部和颈部的扫描优于单个区域.恶化的结果(中风,ICH,与CoW正常的患者相比,CoW异常的患者观察到了抗血栓形成前的临床显着出血)。CoW异常患者的中风发生率高于CoW解剖结构正常的患者,尤其是在中断抗血栓治疗时。这强调了CoW异常患者需要严格的抗血栓治疗方案,并可能表明CoW异常患者将从更多不同的治疗中受益。在扫描BCVI时,强调需要包括CoW解剖结构。
方法:三级,预后/流行病学。
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.
METHODS: Level III, Prognostic/Epidemiological.