Long-term follow-up of blunt cerebrovascular injuries: Does time heal all wounds?.

Background: The short-term natural history of blunt cerebrovascular injuries (BCVI) has been previously described in the literature, but the purpose of this study is to analyze long-term serial follow-up and lesion progression of BCVI. Methods: This is a single institution's retrospective review of a prospectively collected database over four years (2009-2013). All patients diagnosed with BCVI by CT scan were identified and injuries graded based on modified Denver scale. Management followed institutional algorithm: initial whole body contrast enhanced CT scan, followed by CT angiography at 24-72 hours, 5-7 days, 4-6 weeks, and 3 months post-injury. All follow-up imaging, medication management, and clinical outcomes through 6 months following injury were recorded. Results: There were 379 patients with 509 injuries identified. 381 injuries were diagnosed as BCVI on first CT (126 grade 1, 116 grade II, 69 grade III, and 70 grade IV injuries); 100 'indeterminate' on WBCT; 28 injuries were found in patients reimaged only for lesions detected in other vessels. 60% were male, mean age was 46.5 years (SD 19.9), 65% white, and 62% were victims of a motor vehicle crash. Most frequently, grade I injuries were resolved at all subsequent time points. Up to 30% of grade II injuries worsened, but nearly 50% improved or resolved. 46% of injuries originally not detected were subsequently diagnosed as grade III injuries. Greater than 70% of all imaged grade III and IV injuries remained unchanged at all subsequent time points. Conclusions: This study revealed that there are many changes in grade throughout the six month time period, especially the lesions that start out undetectable or indeterminate which become various grade injuries. Low grade injuries (grades I and II) are likely to remain stable and eventually resolve. Higher grade injuries (grades III and IV) persist, many up to six months. Inpatient treatment with antiplatelet or anticoagulation did not affect BCVI progression. Level of Evidence: III; Study Type: Prognostic (C) 2016 Lippincott Williams & Wilkins, Inc.

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