• Dennis Hundersmarck, Willem-Bart M Slooff, Jelle F Homans, van der VlietQuirine M JQMJDepartment of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands., Nizar Moayeri, Falco Hietbrink, Gert J de Borst, Fetullah Cumhur Öner, MuijsSander P JSPJDepartment of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands., and LeenenLuke P HLPHDepartment of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands..
• Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
• Eur J Trauma Emerg Surg. 2021 Feb 1; 47 (1): 161-170.

PurposeBlunt cerebrovascular injuries (BCVI), which can result in ischemic stroke, are identified in 1-2% of all blunt trauma patients. Computed tomography angiography (CTA) scanning has improved and is the diagnostic modality of choice in BCVI suspected patients. Data about long-term functional outcomes and the incidence of ischemic stroke after BCVI are limited. The aim of this study was to determine BCVI incidence in relation to imaging modality improvements and to determine long-term functional outcomes.MethodsAll consecutive trauma patients from 2007 to 2016 with BCVI were identified from the level 1 trauma center prospective trauma database. Three periods were identified where CTA diagnostic modalities for trauma patients were improved. Long-term functional outcomes using the EuroQol six-dimensional (EQ-6D™) were determined.ResultsSeventy-one BCVI patients were identified among the 12.122 (0.59%) blunt trauma patients. In the first period BCVI incidence among the overall study cohort, polytrauma, basilar skull fracture and cervical trauma subgroups was found to be 0.3%, 0.9%, 1.2%, 4.6%, respectively, which more than doubled towards the third period (0.8, 2.4, 1.9 and 8.5% respectively). Ischemic stroke as a result of BCVI was found in 20 patients (28%). In-hospital stroke rate was lower in patients receiving antiplatelet therapy (p < 0.01). Six in-hospital deaths were BCVI related. Long-term follow-up (follow-up rate of 83%) demonstrated lower functional outcomes compared to Dutch reference populations (p < 0.01). Ischemic stroke was identified as a major cause of functional impairment at long-term follow-up.ConclusionsImproved CTA diagnostic modalities have increased BCVI incidence. Furthermore, BCVI patients reported significant functional impairment at long-term follow-up. Antiplatelet therapy showed a significant effect on in-hospital stroke rate reduction.

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