Best practice guidelines for blunt cerebrovascular injury (BCVI)

Tor Brommeland, Eirik Helseth, Mads Aarhus, Kent Gøran Moen, Stig Dyrskog, Bo Bergholt, Zandra Olivecrona, Elisabeth Jeppesen, Tor Brommeland, Eirik Helseth, Mads Aarhus, Kent Gøran Moen, Stig Dyrskog, Bo Bergholt, Zandra Olivecrona, Elisabeth Jeppesen

Abstract

Blunt cerebrovascular injury (BCVI) is a non-penetrating injury to the carotid and/or vertebral artery that may cause stroke in trauma patients. Historically BCVI has been considered rare but more recent publications indicate an overall incidence of 1-2% in the in-hospital trauma population and as high as 9% in patients with severe head injury. The indications for screening, treatment and follow-up of these patients have been controversial for years with few clear recommendations. In an attempt to provide a clinically oriented guideline for the handling of BCVI patients a working committee was created. The current guideline is the end result of this committees work. It is based on a systematic literature search and critical review of all available publications in addition to a standardized consensus process. We recommend using the expanded Denver screening criteria and CT angiography (CTA) for the detection of BCVI. Early antithrombotic treatment should be commenced as soon as considered safe and continued for at least 3 months. A CTA at 7 days to confirm or discard the diagnosis as well as a final imaging control at 3 months should be performed.

Keywords: CT angiography; Guidelines; Screening; Trauma; Vascular injury.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable as this is a systematic review based on published literature.

Consent for publication

Not applicable as this is a systematic review.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram for selection of included studies
Fig. 2
Fig. 2
Flow-diagram summarizing the current guidelines for screening, treatment and followup of patients with BCVI

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