Presence of intraluminal thrombus in grade 2 blunt cerebrovascular injuries does not increase risk of stroke in trauma patients.

Abstract

As screening protocols for blunt cerebrovascular injuries (BCVI) have improved, the incidence of these injuries has increased among trauma patients. Grade 2 BCVIs represent a heterogeneous group of vascular injuries and include injuries with thrombus. We hypothesize that the presence of intraluminal thrombus in patients with grade 2 BCVI is associated with a higher incidence of stroke compared to those without thrombus. We conducted a single-center retrospective review of trauma patients diagnosed with BCVI at a Level I Trauma Center from November 2015 to October 2023. Demographic and injury characteristics were obtained from the institutional trauma registry. Detailed chart reviews were performed to assess imaging findings, stroke incidence, interventions, and follow-up outcomes. Additionally, all grade 2 BCVIs underwent secondary review by neuroradiologists to confirm grade and to identify whether thrombus was present. We identified a total of 39 patients with at least one grade 2 BCVI. The overall stroke rate among those with grade 2 BCVI was 23% (n = 9). Intraluminal thrombus was present in 31% of patients (n = 12); however, the stroke rate among these patients was similar (25%, n = 3). Incidence of stroke did not significantly differ based on whether patients received an intervention, anti-platelet therapy, or no therapy. Follow-up imaging was performed in 64% of patients (n = 25), demonstrating that 24% of injuries resolved, 24% improved, 40% remained stable, and 16% progressed. Nearly two-thirds of patients (n = 25) underwent at least one repeat CTA during their hospitalization or outpatient follow-up with a median number of 38 days to repeat imaging when performed. Although grade 2 BCVIs are often considered lower risk injuries, our findings indicate that over 20% of affected patients experience a stroke. The presence of intraluminal thrombus was not associated with an increased risk of stroke. These findings support the early initiation of antithrombotic therapy in patients with grade 2 BCVI to mitigate stroke risk.