Endovascular Intervention in Internal Carotid Artery Blunt Cerebrovascular Injury: An EAST Multicenter Study
Background Use of endovascular intervention (EI) for blunt cerebrovascular injury (BCVI) is without consensus guidelines. Rates of EI use and radiographic characteristics of BCVI undergoing EI nationally are unknown. Methods A post-hoc analysis of a prospective, observational study at 16 U.S. trauma...
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| Veröffentlicht in: | The American surgeon 2022-08, Vol.88 (8), p.1962-1969 |
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| creator | Lauerman, Margaret Esposito, Emily Spalding, Chance Simpson, Joshua Dunn, Julie A. Zier, Linda Burruss, Sigrid Kim, Paul Jacobson, Lewis E. Williams, Jamie Nahmias, Jeffry Grigorian, Areg Harmon, Laura Gergen, Anna Chatoor, Matthew Rattan, Rishi Young, Andrew J. Pascual, Jose L. Murry, Jason Ong, Adrian W. Muller, Alison Sandhu, Rovinder S. Appelbaum, Rachel Bugaev, Nikolay Tatar, Antony Zreik, Khaled Lieser, Mark J. Scalea, Thomas M. Stein, Deborah M. |
| description | Background
Use of endovascular intervention (EI) for blunt cerebrovascular injury (BCVI) is without consensus guidelines. Rates of EI use and radiographic characteristics of BCVI undergoing EI nationally are unknown.
Methods
A post-hoc analysis of a prospective, observational study at 16 U.S. trauma centers from 2018 to 2020 was conducted. Internal carotid artery (ICA) BCVI was included. The primary outcome was EI use. Multivariable logistic regression was performed for predictors of EI use.
Results
From 332 ICA BCVI included, 21 (6.3%) underwent EI. 0/145 (0%) grade 1, 8/101 (7.9%) grade 2, 12/51 (23.5%) grade 3, and 1/20 (5.0%) grade 4 ICA BCVI underwent EI. Stroke occurred in 6/21 (28.6%) ICA BCVI undergoing EI and in 33/311 (10.6%) not undergoing EI (P = .03), with all strokes with EI use occurring prior to or at the same time as EI. Percentage of luminal stenosis (37.75 vs 20.29%, P = .01) and median pseudoaneurysm size (9.00 mm vs 3.00 mm, P = .01) were greater in ICA BCVI undergoing EI. On logistic regression, only pseudoaneurysm size was associated with EI (odds ratio 1.205, 95% CI 1.035-1.404, P = .02). Of the 8 grade 2 ICA BCVI undergoing EI, 3/8 were grade 2 and 5/8 were grade 3 prior to EI. Of the 12 grade 3 ICA BCVI undergoing EI, 11/12 were grade 3 and 1/12 was a grade 2 ICA BCVI prior to EI.
Discussion
Pseudoaneurysm size is associated with use of EI for ICA BCVI. Stroke is more common in ICA BCVI with EI but did not occur after EI use. |
| doi_str_mv | 10.1177/00031348221078958 |
| format | Article |
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Use of endovascular intervention (EI) for blunt cerebrovascular injury (BCVI) is without consensus guidelines. Rates of EI use and radiographic characteristics of BCVI undergoing EI nationally are unknown.
Methods
A post-hoc analysis of a prospective, observational study at 16 U.S. trauma centers from 2018 to 2020 was conducted. Internal carotid artery (ICA) BCVI was included. The primary outcome was EI use. Multivariable logistic regression was performed for predictors of EI use.
Results
From 332 ICA BCVI included, 21 (6.3%) underwent EI. 0/145 (0%) grade 1, 8/101 (7.9%) grade 2, 12/51 (23.5%) grade 3, and 1/20 (5.0%) grade 4 ICA BCVI underwent EI. Stroke occurred in 6/21 (28.6%) ICA BCVI undergoing EI and in 33/311 (10.6%) not undergoing EI (P = .03), with all strokes with EI use occurring prior to or at the same time as EI. Percentage of luminal stenosis (37.75 vs 20.29%, P = .01) and median pseudoaneurysm size (9.00 mm vs 3.00 mm, P = .01) were greater in ICA BCVI undergoing EI. On logistic regression, only pseudoaneurysm size was associated with EI (odds ratio 1.205, 95% CI 1.035-1.404, P = .02). Of the 8 grade 2 ICA BCVI undergoing EI, 3/8 were grade 2 and 5/8 were grade 3 prior to EI. Of the 12 grade 3 ICA BCVI undergoing EI, 11/12 were grade 3 and 1/12 was a grade 2 ICA BCVI prior to EI.
Discussion
Pseudoaneurysm size is associated with use of EI for ICA BCVI. Stroke is more common in ICA BCVI with EI but did not occur after EI use.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/00031348221078958</identifier><identifier>PMID: 35437020</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Anticoagulants ; Aspirin ; Blood clots ; Cardiovascular system ; Carotid arteries ; Carotid artery ; Embolization ; Hospitalization ; Intervention ; Observational studies ; Patients ; Pseudoaneurysm ; Statistical analysis ; Stenosis ; Stroke ; Trauma</subject><ispartof>The American surgeon, 2022-08, Vol.88 (8), p.1962-1969</ispartof><rights>The Author(s) 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-19e891ab5e76918e98908dc3336c1e32cc97908d413130d788f43c96d5a9736b3</citedby><cites>FETCH-LOGICAL-c368t-19e891ab5e76918e98908dc3336c1e32cc97908d413130d788f43c96d5a9736b3</cites><orcidid>0000-0002-9381-9060</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/00031348221078958$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/00031348221078958$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35437020$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lauerman, Margaret</creatorcontrib><creatorcontrib>Esposito, Emily</creatorcontrib><creatorcontrib>Spalding, Chance</creatorcontrib><creatorcontrib>Simpson, Joshua</creatorcontrib><creatorcontrib>Dunn, Julie A.</creatorcontrib><creatorcontrib>Zier, Linda</creatorcontrib><creatorcontrib>Burruss, Sigrid</creatorcontrib><creatorcontrib>Kim, Paul</creatorcontrib><creatorcontrib>Jacobson, Lewis E.</creatorcontrib><creatorcontrib>Williams, Jamie</creatorcontrib><creatorcontrib>Nahmias, Jeffry</creatorcontrib><creatorcontrib>Grigorian, Areg</creatorcontrib><creatorcontrib>Harmon, Laura</creatorcontrib><creatorcontrib>Gergen, Anna</creatorcontrib><creatorcontrib>Chatoor, Matthew</creatorcontrib><creatorcontrib>Rattan, Rishi</creatorcontrib><creatorcontrib>Young, Andrew J.</creatorcontrib><creatorcontrib>Pascual, Jose L.</creatorcontrib><creatorcontrib>Murry, Jason</creatorcontrib><creatorcontrib>Ong, Adrian W.</creatorcontrib><creatorcontrib>Muller, Alison</creatorcontrib><creatorcontrib>Sandhu, Rovinder S.</creatorcontrib><creatorcontrib>Appelbaum, Rachel</creatorcontrib><creatorcontrib>Bugaev, Nikolay</creatorcontrib><creatorcontrib>Tatar, Antony</creatorcontrib><creatorcontrib>Zreik, Khaled</creatorcontrib><creatorcontrib>Lieser, Mark J.</creatorcontrib><creatorcontrib>Scalea, Thomas M.</creatorcontrib><creatorcontrib>Stein, Deborah M.</creatorcontrib><title>Endovascular Intervention in Internal Carotid Artery Blunt Cerebrovascular Injury: An EAST Multicenter Study</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>Background
Use of endovascular intervention (EI) for blunt cerebrovascular injury (BCVI) is without consensus guidelines. Rates of EI use and radiographic characteristics of BCVI undergoing EI nationally are unknown.
Methods
A post-hoc analysis of a prospective, observational study at 16 U.S. trauma centers from 2018 to 2020 was conducted. Internal carotid artery (ICA) BCVI was included. The primary outcome was EI use. Multivariable logistic regression was performed for predictors of EI use.
Results
From 332 ICA BCVI included, 21 (6.3%) underwent EI. 0/145 (0%) grade 1, 8/101 (7.9%) grade 2, 12/51 (23.5%) grade 3, and 1/20 (5.0%) grade 4 ICA BCVI underwent EI. Stroke occurred in 6/21 (28.6%) ICA BCVI undergoing EI and in 33/311 (10.6%) not undergoing EI (P = .03), with all strokes with EI use occurring prior to or at the same time as EI. Percentage of luminal stenosis (37.75 vs 20.29%, P = .01) and median pseudoaneurysm size (9.00 mm vs 3.00 mm, P = .01) were greater in ICA BCVI undergoing EI. On logistic regression, only pseudoaneurysm size was associated with EI (odds ratio 1.205, 95% CI 1.035-1.404, P = .02). Of the 8 grade 2 ICA BCVI undergoing EI, 3/8 were grade 2 and 5/8 were grade 3 prior to EI. Of the 12 grade 3 ICA BCVI undergoing EI, 11/12 were grade 3 and 1/12 was a grade 2 ICA BCVI prior to EI.
Discussion
Pseudoaneurysm size is associated with use of EI for ICA BCVI. Stroke is more common in ICA BCVI with EI but did not occur after EI use.</description><subject>Anticoagulants</subject><subject>Aspirin</subject><subject>Blood clots</subject><subject>Cardiovascular system</subject><subject>Carotid arteries</subject><subject>Carotid artery</subject><subject>Embolization</subject><subject>Hospitalization</subject><subject>Intervention</subject><subject>Observational studies</subject><subject>Patients</subject><subject>Pseudoaneurysm</subject><subject>Statistical analysis</subject><subject>Stenosis</subject><subject>Stroke</subject><subject>Trauma</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp1kU1PwzAMhiMEYmPwA7igSFy4dCRN0yTcSjVg0hCHjXOVphnq1KUjaSb139Oq40MgTpbt530t2wBcYjTFmLFbhBDBJOJhiBHjgvIjMMaU0kDwkByDcd8PemAEzpzbdGkUU3wKRoRGhKEQjUE1M0W9l075Slo4N422e22asjawNENuZAVTaeumLGBiu0IL7ytvGphqq3P7U73xtr2DiYGzZLmCz75qSqV7D7hsfNGeg5O1rJy-OMQJeH2YrdKnYPHyOE-TRaBIzJsAC80FljnVLBaYa8EF4oUihMQKaxIqJVhfiXC3PSoY5-uIKBEXVApG4pxMwM3gu7P1u9euybalU7qqpNG1d1kY05ByQhjr0Otf6Kb2_co9xXkUIybCjsIDpWztnNXrbGfLrbRthlHWvyL784pOc3Vw9vlWF1-Kz9t3wHQAnHzT32P_d_wADVWPeg</recordid><startdate>20220801</startdate><enddate>20220801</enddate><creator>Lauerman, Margaret</creator><creator>Esposito, Emily</creator><creator>Spalding, Chance</creator><creator>Simpson, Joshua</creator><creator>Dunn, Julie A.</creator><creator>Zier, Linda</creator><creator>Burruss, Sigrid</creator><creator>Kim, Paul</creator><creator>Jacobson, Lewis E.</creator><creator>Williams, Jamie</creator><creator>Nahmias, Jeffry</creator><creator>Grigorian, Areg</creator><creator>Harmon, Laura</creator><creator>Gergen, Anna</creator><creator>Chatoor, Matthew</creator><creator>Rattan, Rishi</creator><creator>Young, Andrew J.</creator><creator>Pascual, Jose L.</creator><creator>Murry, Jason</creator><creator>Ong, Adrian W.</creator><creator>Muller, Alison</creator><creator>Sandhu, Rovinder S.</creator><creator>Appelbaum, Rachel</creator><creator>Bugaev, Nikolay</creator><creator>Tatar, Antony</creator><creator>Zreik, Khaled</creator><creator>Lieser, Mark J.</creator><creator>Scalea, Thomas M.</creator><creator>Stein, Deborah M.</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7T7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9381-9060</orcidid></search><sort><creationdate>20220801</creationdate><title>Endovascular Intervention in Internal Carotid Artery Blunt Cerebrovascular Injury: An EAST Multicenter Study</title><author>Lauerman, Margaret ; Esposito, Emily ; Spalding, Chance ; Simpson, Joshua ; Dunn, Julie A. ; Zier, Linda ; Burruss, Sigrid ; Kim, Paul ; Jacobson, Lewis E. ; Williams, Jamie ; Nahmias, Jeffry ; Grigorian, Areg ; Harmon, Laura ; Gergen, Anna ; Chatoor, Matthew ; Rattan, Rishi ; Young, Andrew J. ; Pascual, Jose L. ; Murry, Jason ; Ong, Adrian W. ; Muller, Alison ; Sandhu, Rovinder S. ; Appelbaum, Rachel ; Bugaev, Nikolay ; Tatar, Antony ; Zreik, Khaled ; Lieser, Mark J. ; Scalea, Thomas M. ; Stein, Deborah M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-19e891ab5e76918e98908dc3336c1e32cc97908d413130d788f43c96d5a9736b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Anticoagulants</topic><topic>Aspirin</topic><topic>Blood clots</topic><topic>Cardiovascular system</topic><topic>Carotid arteries</topic><topic>Carotid artery</topic><topic>Embolization</topic><topic>Hospitalization</topic><topic>Intervention</topic><topic>Observational studies</topic><topic>Patients</topic><topic>Pseudoaneurysm</topic><topic>Statistical analysis</topic><topic>Stenosis</topic><topic>Stroke</topic><topic>Trauma</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lauerman, Margaret</creatorcontrib><creatorcontrib>Esposito, Emily</creatorcontrib><creatorcontrib>Spalding, Chance</creatorcontrib><creatorcontrib>Simpson, Joshua</creatorcontrib><creatorcontrib>Dunn, Julie A.</creatorcontrib><creatorcontrib>Zier, Linda</creatorcontrib><creatorcontrib>Burruss, Sigrid</creatorcontrib><creatorcontrib>Kim, Paul</creatorcontrib><creatorcontrib>Jacobson, Lewis E.</creatorcontrib><creatorcontrib>Williams, Jamie</creatorcontrib><creatorcontrib>Nahmias, Jeffry</creatorcontrib><creatorcontrib>Grigorian, Areg</creatorcontrib><creatorcontrib>Harmon, Laura</creatorcontrib><creatorcontrib>Gergen, Anna</creatorcontrib><creatorcontrib>Chatoor, Matthew</creatorcontrib><creatorcontrib>Rattan, Rishi</creatorcontrib><creatorcontrib>Young, Andrew J.</creatorcontrib><creatorcontrib>Pascual, Jose L.</creatorcontrib><creatorcontrib>Murry, Jason</creatorcontrib><creatorcontrib>Ong, Adrian W.</creatorcontrib><creatorcontrib>Muller, Alison</creatorcontrib><creatorcontrib>Sandhu, Rovinder S.</creatorcontrib><creatorcontrib>Appelbaum, Rachel</creatorcontrib><creatorcontrib>Bugaev, Nikolay</creatorcontrib><creatorcontrib>Tatar, Antony</creatorcontrib><creatorcontrib>Zreik, Khaled</creatorcontrib><creatorcontrib>Lieser, Mark J.</creatorcontrib><creatorcontrib>Scalea, Thomas M.</creatorcontrib><creatorcontrib>Stein, Deborah M.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lauerman, Margaret</au><au>Esposito, Emily</au><au>Spalding, Chance</au><au>Simpson, Joshua</au><au>Dunn, Julie A.</au><au>Zier, Linda</au><au>Burruss, Sigrid</au><au>Kim, Paul</au><au>Jacobson, Lewis E.</au><au>Williams, Jamie</au><au>Nahmias, Jeffry</au><au>Grigorian, Areg</au><au>Harmon, Laura</au><au>Gergen, Anna</au><au>Chatoor, Matthew</au><au>Rattan, Rishi</au><au>Young, Andrew J.</au><au>Pascual, Jose L.</au><au>Murry, Jason</au><au>Ong, Adrian W.</au><au>Muller, Alison</au><au>Sandhu, Rovinder S.</au><au>Appelbaum, Rachel</au><au>Bugaev, Nikolay</au><au>Tatar, Antony</au><au>Zreik, Khaled</au><au>Lieser, Mark J.</au><au>Scalea, Thomas M.</au><au>Stein, Deborah M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endovascular Intervention in Internal Carotid Artery Blunt Cerebrovascular Injury: An EAST Multicenter Study</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2022-08-01</date><risdate>2022</risdate><volume>88</volume><issue>8</issue><spage>1962</spage><epage>1969</epage><pages>1962-1969</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>Background
Use of endovascular intervention (EI) for blunt cerebrovascular injury (BCVI) is without consensus guidelines. Rates of EI use and radiographic characteristics of BCVI undergoing EI nationally are unknown.
Methods
A post-hoc analysis of a prospective, observational study at 16 U.S. trauma centers from 2018 to 2020 was conducted. Internal carotid artery (ICA) BCVI was included. The primary outcome was EI use. Multivariable logistic regression was performed for predictors of EI use.
Results
From 332 ICA BCVI included, 21 (6.3%) underwent EI. 0/145 (0%) grade 1, 8/101 (7.9%) grade 2, 12/51 (23.5%) grade 3, and 1/20 (5.0%) grade 4 ICA BCVI underwent EI. Stroke occurred in 6/21 (28.6%) ICA BCVI undergoing EI and in 33/311 (10.6%) not undergoing EI (P = .03), with all strokes with EI use occurring prior to or at the same time as EI. Percentage of luminal stenosis (37.75 vs 20.29%, P = .01) and median pseudoaneurysm size (9.00 mm vs 3.00 mm, P = .01) were greater in ICA BCVI undergoing EI. On logistic regression, only pseudoaneurysm size was associated with EI (odds ratio 1.205, 95% CI 1.035-1.404, P = .02). Of the 8 grade 2 ICA BCVI undergoing EI, 3/8 were grade 2 and 5/8 were grade 3 prior to EI. Of the 12 grade 3 ICA BCVI undergoing EI, 11/12 were grade 3 and 1/12 was a grade 2 ICA BCVI prior to EI.
Discussion
Pseudoaneurysm size is associated with use of EI for ICA BCVI. Stroke is more common in ICA BCVI with EI but did not occur after EI use.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>35437020</pmid><doi>10.1177/00031348221078958</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-9381-9060</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | The American surgeon, 2022-08, Vol.88 (8), p.1962-1969 |
| issn | 0003-1348 1555-9823 |
| language | eng |
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| source | SAGE Complete |
| subjects | Anticoagulants Aspirin Blood clots Cardiovascular system Carotid arteries Carotid artery Embolization Hospitalization Intervention Observational studies Patients Pseudoaneurysm Statistical analysis Stenosis Stroke Trauma |
| title | Endovascular Intervention in Internal Carotid Artery Blunt Cerebrovascular Injury: An EAST Multicenter Study |
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