The Spectrum of Vascular Injuries Secondary to Traumatic Brain Injury: A Single-Center Study Based on Digital Subtraction Angiography

Abstract

Background

To profile the spectrum of traumatic neurovascular injuries associated with traumatic brain injury (TBI) and their outcomes over ten years in a single central academic hospital.

Methods

Retrospective review of the TBI database to identify patients who underwent digital subtraction angiography (DSA) for suspected underlying intracranial and extracranial vascular injuries managed between January 2012 and December 2022. Medical records were analyzed for demographics, computed tomography (CT) angiography and DSA findings, and neurosurgical intervention.

Results

A total of 143 patients (median age 28 years) were included in the study. The majority of patients were male (89.5%). DSA confirmed vascular injuries in 76 (53.1%) patients. Injured blood vessels include internal carotid artery (22.4%), middle cerebral artery (14.0%), middle meningeal artery (3.5%), and others. DSA was negative in 67 (46.9%) of the TBI patients. Mechanisms of penetrating injury include knives, machetes, and screwdrivers. Closed injuries were commonly due to motor vehicle accidents (11.2%) and falls from a height (5.6%). The most common type of vascular injury is pseudoaneurysm 40 (33.1%). Dissection with vessel cut-off, and arteriovenous fistulas accounted for 17%, whilst traumatic carotid cavernous fistulas were seen in 15.4%. Most patients (60.1%) had Glasgow Coma Scale 15 at discharge.

Conclusions

The incidence of confirmed traumatic vascular injuries is high in DSA patients with suspected vascular injuries on CT/CT angiography after penetrating head and neck trauma. Vascular injury remains one of the major consequences of penetrating TBI, with associated morbidity and mortality. However, most patients in our series recover well with minimal perioperative and postoperative complications.