Journal article
Which Patients Receive Diagnostic Angiography? An EAST Multicenter Study Analysis of Internal Carotid Artery Blunt Cerebrovascular Injury
The American surgeon, v 89(12), pp 5183-5190
01 Dec 2023
PMID: 36417771
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: Digital subtraction angiography (DSA) is the gold standard radiologic modality in blunt cerebrovascular injury (BCVI). However, computerized tomography angiography (CTA) is primarily used in modern practice with CTA's widespread availability and the decreased stroke rate with CTA use. The frequency and indications for DSA in BCVI is undefined. We hypothesized that DSA use in internal carotid artery (ICA) BCVI would be infrequent and dependent on radiologic features.
Methods: This was a post hoc analysis of an EAST multicenter, prospective, observational trial of 16 trauma centers for stroke factors in BCVI. ICA BCVI was divided into those undergoing DSA and not undergoing DSA (no-DSA). Only ICA BCVI was included.
Results: 332 ICA BCVI were included, 221 (66.6%) no-DSA and 111 (33.4%) DSA. Lower hospital trauma volume, non-urban environment, and non-academic status were associated with DSA use (all P <= .001). BCVI grade (P = .02) and presence of luminal stenosis (P = .005) were associated with DSA use while pseudoaneurysm presence was not. Median time to DSA was 1 hour. The most common indication for angiography was to determine the presence of injury in 71 (64%) ICA BCVI, followed by determining grade of injury in 16 (14.4%) and concerning imaging characteristics in 12 (10.8%). BCVI grade on initial imaging and on DSA were equivalent in 94 (84.7%) ICA BCVI.
Discussion: DSA is frequently used in ICA BCVI, primarily early in the hospital course for injury diagnosis and grade determination. DSA appears primarily driven by hospital type, BCVI grade, and luminal stenosis.
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Details
- Title
- Which Patients Receive Diagnostic Angiography? An EAST Multicenter Study Analysis of Internal Carotid Artery Blunt Cerebrovascular Injury
- Creators
- Sohil Ardeshna - R Adams Cowley Shock Trauma Ctr, 22 South Greene St, Baltimore, MD 21201 USAEmily Esposito - R Adams Cowley Shock Trauma Ctr, 22 South Greene St, Baltimore, MD 21201 USAChance Spalding - Grant Medical CenterJulie Dunn - University of Colorado Anschutz Medical CampusJeffry Nahmias - University of California, IrvineAreg Grigorian - University of California, IrvineLaura Harmon - University of Colorado DenverAnna Gergen - University of Colorado DenverAndrew Young - University of PennsylvaniaJose Pascual - University of PennsylvaniaJason Murry - The University of Texas Health Science Center at TylerAdrian Ong - Reading HospitalRachel Appelbaum - Wake Forest UniversityNikolay Bugaev - Tufts UniversityAntony Tatar - Tufts UniversityKhaled Zreik - Sanford HealthThomas M. Scalea - R Adams Cowley Shock Trauma Ctr, 22 South Greene St, Baltimore, MD 21201 USADeborah Stein - R Adams Cowley Shock Trauma Ctr, 22 South Greene St, Baltimore, MD 21201 USAMargaret Lauerman - R Adams Cowley Shock Trauma Ctr, 22 South Greene St, Baltimore, MD 21201 USA
- Publication Details
- The American surgeon, v 89(12), pp 5183-5190
- Publisher
- Sage
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000890015300001
- Scopus ID
- 2-s2.0-85142730345
- Other Identifier
- 991022020735104721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Surgery