Early vs. late computed tomography angiography in blunt cerebrovascular injuries: a national analysis of clinical outcomes across injury grade and location.

Abstract

Purpose: Blunt cerebrovascular injury (BCVI) is a potentially devastating complication of trauma. This study aims to evaluate the impact of Computed Tomography Angiography (CTA) timing on stroke and outcomes in BCVI, and to identify predictors of stroke.

Methods: The ACS-TQIP database (2017-2024) was used to analyze the effect of CTA timing on outcomes and to identify predictors of stroke using multivariable regression models in adult polytrauma patients with moderate-severe BCVI. Patients were stratified by injury type, grade, and concomitant traumatic brain injury (TBI). The primary outcome was stroke occurrence, and secondary outcomes included mortality, complications, ICU-LOS, VFDs, and discharge disposition.

Results: Early CTA was associated with reduced stroke (aOR: 0.394, p < 0.001), decreased complications, and reduced intensive care unit length of stay (ICU-LOS) (β: -2.425, p < 0.001), but increased mortality. Among patients with isolated carotid or vertebral injuries, early CTA reduced strokes without increasing mortality. Low-grade injuries experienced reduced stroke (aOR: 0.396, p < 0.001) and shorter ICU-LOS (β: -1.769, p = 0.006). In contrast, high-grade injuries and concomitant moderate-severe TBI were accompanied by increases in mortality. Advanced age (aOR: 1.352, p = 0.047), high-grade injuries (aOR: 2.297, p < 0.001), severe injury severity score (aOR: 2.791, p < 0.001), and concomitant TBI (aOR: 1.522, p < 0.001) were predictors of stroke.

Conclusion: Early CTA is associated with reduced stroke risk and improved outcomes, including fewer complications and shorter ICU stay. Benefits are greatest in low-grade injuries and isolated carotid or vertebral involvement. In contrast, high-grade injuries and concomitant moderate-severe TBI show reduced stroke but increased mortality, likely reflecting greater injury severity.