Seminars in Ultrasound, CT and MRI
Volume 28, Issue 2 , Pages 101-108 , April 2007

Screening for Blunt Cerebrovascular Injuries: The Essential Role of Computed Tomography Angiography

  • Dirk Stengel, MD, PhD, MSc

      Affiliations

    • Center for Clinical Research and Department of Trauma and Orthopaedic Surgery, Berlin, Germany.
    • Corresponding Author InformationAddress reprint requests to Dirk Stengel, MD, PhD, MSc, Center for Clinical Research, Unfallkrankenhaus Berlin Trauma Center, Warener Str 7, 12683 Berlin, Germany.
    • ,
  • Grit Rademacher, MD

      Affiliations

    • Institute of Radiology, Unfallkrankenhaus Berlin Trauma Center, Berlin, Germany.
    • ,
  • Beate Hanson, MD, MPH

      Affiliations

    • AO Clinical Investigation and Documentation, Zurich, Switzerland.
    • ,
  • Axel Ekkernkamp, MD, PhD

      Affiliations

    • Center for Clinical Research and Department of Trauma and Orthopaedic Surgery, Berlin, Germany.
    • ,
  • Sven Mutze, MD, PhD

      Affiliations

    • Institute of Radiology, Unfallkrankenhaus Berlin Trauma Center, Berlin, Germany.

References 

  1. In:  Mock C,  Lormand JD,  Goosen J,  Joshipura M,  Peden M editor. Guidelines for Essential Trauma Care. Geneva: World Health Organization; 2004;
  2. Ogura H, Tanaka H, Koh T, et al. Priming, second-hit priming, and apoptosis in leukocytes from trauma patients. J Trauma. 1999;46:774–781
  3. Giannoudis PV, Smith RM, Bellamy MC, et al. Stimulation of the inflammatory system by reamed and unreamed nailing of femoral fractures (An analysis of the second hit). J Bone Joint Surg Br. 1999;81:356–361
  4. Cogbill TH, Moore EE, Meissner M, Fischer RP, Hoyt DB, Morris JA, et al The spectrum of blunt injury to the carotid artery: a multicenter perspective. J Trauma. 1994;37:473–479
  5. Fabian TC, Patton JH, Croce MA, et al. Blunt carotid injury (Importance of early diagnosis and anticoagulant therapy). Ann Surg. 1996;223:513–522
  6. Biffl WL, Moore EE, Ryu RK, et al. The unrecognized epidemic of blunt carotid arterial injuries: early diagnosis improves neurologic outcome. Ann Surg. 1998;228:462–470
  7. Cothren CC, Moore EE, Biffl WL, et al. Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg. 2004;139:540–545
  8. Cothren CC, Moore EE, Ray CE, et al. Screening for blunt cerebrovascular injuries is cost-effective. Am J Surg. 2005;190:845–849
  9. Biffl WL, Ray CE, Moore EE, et al. Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg. 2002;235:699–706
  10. Moar JJ. Traumatic rupture of the cervical carotid arteries: an autopsy and histopathological study of 200 cases. Forensic Sci Int. 1987;34:227–244
  11. Davis JW, Holbrook TL, Hoyt DB, Mackersie RC, Field TO, Shackford SR. Blunt carotid artery dissection: incidence, associated injuries, screening, and treatment. J Trauma. 1990;30:1514–1517
  12. Carrillo EH, Osborne DL, Spain DA, Miller FB, Senler SO, Richardson JD. Blunt carotid artery injuries: difficulties with the diagnosis prior to neurologic event. J Trauma. 1999;46:1120–1125
  13. Rogers FB, Baker EF, Osler TM, Shackford SR, Wald SL, Vieco P. Computed tomographic angiography as a screening modality for blunt cervical arterial injuries: preliminary results. J Trauma. 1999;46:380–385
  14. Biffl WL, Moore EE, Offner PJ, et al. Blunt carotid arterial injuries: implications of a new grading scale. J Trauma. 1999;47:845–853
  15. Hughes KM, Collier B, Greene KA, Kurek S. Traumatic carotid artery dissection: a significant incidental finding. Am Surg. 2000;66:1023–1027
  16. Kerwin AJ, Bynoe RP, Murray J, et al. Liberalized screening for blunt carotid and vertebral artery injuries is justified. J Trauma. 2001;51:308–314
  17. McKevitt EC, Kirkpatrick AW, Vertesi L, Granger R, Simons RK. Blunt vascular neck injuries: diagnosis and outcomes of extracranial vessel injury. J Trauma. 2002;53:472–476
  18. Berne JD, Reuland KS, Villarreal DH, et al. Sixteen-slice multi-detector computed tomographic angiography improves the accuracy of screening for blunt cerebrovascular injury. J Trauma. 2006;60:1204–1209
  19. Bub LD, Hollingworth W, Jarvik JG, Hallam DK. Screening for blunt cerebrovascular injury: evaluating the accuracy of multidetector computed tomographic angiography. J Trauma. 2005;59:691–697
  20. Mutze S, Rademacher G, Matthes G, et al. Blunt cerebrovascular injury in patients with blunt multiple trauma: diagnostic accuracy of duplex Doppler US and early CT angiography. Radiology. 2005;237:884–892
  21. Martin MJ, Mullenix PS, Steele SR, et al. Functional outcome after blunt and penetrating carotid artery injuries: analysis of the National Trauma Data Bank. J Trauma. 2005;59:860–864
  22. Eastman AL, Chason DP, Perez CL, et al. Computed tomographic angiography for the diagnosis of blunt cervical vascular injury: is it ready for primetime?. J Trauma. 2006;60:925–929
  23. Biffl WL, Egglin T, Benedetto B, Gibbs F, Cioffi WG. Sixteen-slice computed tomographic angiography is a reliable noninvasive screening test for clinically significant blunt cerebrovascular injuries. J Trauma. 2006;60:745–751
  24. Schneidereit NP, Simons R, Nicolaou S, et al. Utility of screening for blunt vascular neck injuries with computed tomographic angiography. J Trauma. 2006;60:209–215
  25. LeBlang SD, Nunez DB. Noninvasive imaging of cervical vascular injuries. AJR Am J Roentgenol. 2000;174:1269–1278
  26. Miller PR, Fabian TC, Croce MA, Cagiannos C, Williams JS, Vang M, et al. Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg. 2002;236:386–393
  27. Biffl WL, Ray CE, Moore EE, et al. Noninvasive diagnosis of blunt cerebrovascular injuries: a preliminary report. J Trauma. 2002;53:850–856
  28. Utter GH, Hollingworth W, Hallam DK, et al. Sixteen-slice CT angiography in patients with suspected blunt carotid and vertebral artery injuries. J Am Coll Surg. 2006;203:838–848
  29. Biffl WL, Moore EE, Elliott JP, et al. The devastating potential of blunt vertebral arterial injuries. Ann Surg. 2000;231:672–681
  30. Nederkoorn PJ, van der Graaf Y, Hunink MG. Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis: a systematic review. Stroke. 2003;34:1324–1332
  31. Rademacher G, Stengel D, Siegmann S, et al. Optimization of contrast agent volume for helical CT in the diagnostic assessment of patients with severe and multiple injuries. J Comput Assist Tomogr. 2002;26:113–118
  32. Hollingworth W, Nathens AB, Kanne JP, et al. The diagnostic accuracy of computed tomography angiography for traumatic or atherosclerotic lesions of the carotid and vertebral arteries: a systematic review. Eur J Radiol. 2003;48:88–102

PII: S0887-2171(07)00017-0

doi: 10.1053/j.sult.2007.01.009

Seminars in Ultrasound, CT and MRI
Volume 28, Issue 2 , Pages 101-108 , April 2007

Article Tools

* Image Usage & Resolution