V.E. Wagner1, V. Arientyl1, A. De Leon Castro3, M. Garcia-Toca1, E. Caddell3, J. Nguyen2, S. Todd3, J.D. Sciarretta1 1Emory University School of Medicine, Surgery, Atlanta, GA, USA 2Morehouse School of Medicine, Surgery, Atlanta, GEORGIA, USA 3Grady Memorial Hospital, Trauma/Acute Care Surgery, Atlanta, GEORGIA, USA
Introduction: Though blunt cerebrovascular injury (BCVI) may be uncommon, its sequela can be highly morbid and life-altering. Current BCVI management recommendations suggest treatment of BCVI, regardless of grade, with aspirin (ASA) or anticoagulation (AC), though dosing may vary between institutions. We sought to evaluate ASA/AC timing in patients with who developed stroke after BCVI at a large level 1 trauma center.
Methods: A retrospective cohort review from 01/2016 to 12/2023 was performed and patients who developed a stroke in the setting of BCVI were included. Demographics, injury location and grade, presence of stroke, hospitalization details, and ASA/AC timing were collected.
Results: 934 patients were found to have BCVI and of these, 35 developed a stroke. They were predominantly male with a median (IQR) age of 41 (29.5 – 61.5) and a median ISS of 30 (26-43). Median AIS Head was 4 (3-5) and median AIS Neck was 3 (3-4). There were 31 carotid artery injuries (8 bilateral), and 28 vertebral artery injuries (5 bilateral). Four were multi-segmental injuries. Seven patients had a single isolated vertebral BCVI and 8 patients had a single isolated carotid BCVI. The breakdown of injury grades were 18 grade I, 15 grade II, 6 grade III, 20 grade IV, and 0 grade V. Fifty-four percent of patients had 2 or more BCVI. Twenty-two patients did not receive ASA/AC before their stroke diagnosis. Of these 22 patients, 5 had ASA/AC held per the request of consulting services due to pending OR. Five patients had evolving intracranial hemorrhage that precluded ASA/AC. Two patients should have received a CTA Neck on admission based on injury patterns but did not until they developed symptoms of a stroke. Four patients did not meet criteria for CTA on initial trauma scans due to their injury pattern while 4 patients presented with stroke symptoms. One patient’s ASA/AC was held for ongoing intrabdominal bleeding and 1 patient did not receive ASA due to a missed recommendation. The remaining 13 patients received ASA/AC before the diagnosis of stroke either upon diagnosis of BCVI (9 patients) or as soon as clinically stable (4 patients). Median hospital and ICU LOS of stay were 23 (13-59) and 17 (11-25) days respectively. Median number of ventilator days were 17 (11-24). 32% of patients were discharged home while 40% were discharged to a rehab facility, 4% to a LTACH, and 16% to a SNF. Eight percent were discharged to hospice and overall mortality was 28.6%.
Conclusion: In review, we noted that 62% of the patients did not receive ASA prior to their stroke diagnosis, while the remaining did but still stroked. The administration of ASA is not uniform despite its recommendations to start. We believe prospective randomized studies looking into ASA timing for those who are at the highest risk for stroke after BCVI are warranted.