Ahead of Print: Incidence of Blunt Craniocervical Artery Injuries: Use of Whole Body CT Trauma Imaging with Adapted CT Angiography
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BACKGROUND: The incidence of traumatic craniocervical artery dissection varies in published trauma series.
OBJECTIVE: To determine the frequency of traumatic craniocervical artery injury in polytrauma patients by using a standardized whole body trauma computed tomography (WBCT) with an adapted CT angiography (CTA) of the craniocervical vessels.
METHODS: 718 consecutive patients requiring a whole body trauma CT (16-row-multi-slice) due to the mechanism of their injury patterns and an Injury Severity Sale of greater than 16 were analyzed prospectively. After cranial scan, the CT angiography of the craniocervical vessels with 40 ml of iodinated contrast agent was performed using bolus tracking.
RESULTS: Overall incidence of blunt carotid and vertebral injuries (BCVI) in the screened population was 1.7%. BCVI were observed in 27.3% of patients with detected isolated cervical spine injuries, and in 3.9% of patients with isolated skull fractures with or without intracranial hemorrhage, whereas 5.3% of patients with combined cervical and cranial lesions were associated with BCVI. In addition, 0.4% of BCVI occured in patients without evidence of head or neck trauma.
CONCLUSION: WBCT CT scan with an adapted scanning protocol for the craniocervical vessels is a fast, safe and feasibel method for detecting vascular injuries. It allows prompt further treatment if necessary. CTA could be a part of a broad screening protocol for craniocervical vessels in documented injuries of the head and neck and in trauma mechanisms influencing the craniocervical region as well.
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