Early CT angiography (CTA) significantly reduces stroke risk and improves clinical outcomes in patients with blunt cerebrovascular injury (BCVI), particularly those with isolated carotid or vertebral injuries, though individualized risk assessment is needed for patients with high-grade injuries or concurrent traumatic brain injury.
- Early CTA reduced stroke risk by 61% in BCVI patients (adjusted odds ratio 0.39)
- Early imaging decreased intensive care unit length of stay by an average of 2.4 days
- Isolated carotid or vertebral injuries showed stroke reduction without increased mortality with early CTA
- Key stroke predictors include advanced age, high-grade injuries, severe injury severity score, and concurrent traumatic brain injury
Early CT angiography (CTA) leads to reduced stroke risk and improved outcomes in patients with blunt cerebrovascular injury (BCVI), according to research published August 5 in Emergency Radiology.
A team led by Adel Elkbuli, MD, from the Orlando Regional Medical Center in Florida found that early CTA reduced strokes without increasing mortality in patients with isolated carotid or vertebral injuries.
“Early CTA of the neck may be considered in adult patients with moderate-to-severe BCVI due to its association with reduced stroke and improved clinical outcomes,” Elkubli and colleagues wrote. “However, increased mortality in high-risk subgroups, including those with high-grade injuries and concomitant TBI, highlights the need for individualized, risk-based decision-making.”
Many BVCI cases are diagnosed after the development of serious complications such as early ischemic stroke. While advancements in technology make CTA more attractive for emergency care, Elkubli et al noted limited evidence toward best timing of CTA imaging.
The Elkubli team studied the impact of CTA timing on stroke and outcomes in BCVI. It also identified predictors of stroke.
The study included data from 16,814 patients in the American College of Surgeons-Trauma Quality Improvement Program (ACS-TQIP) database (2017–2024). Of the total patients, 16,230 received early CTA while 585 received late CTA.
The researchers used multivariable regression models in adult polytrauma patients with moderate-severe BCVI. They stratified patients by injury type, grade, and concomitant traumatic brain injury.
Early CTA showed significant associations with reduced stroke (adjusted odds ratio [aOR]: 0.39, p < 0.001) and decreased complications. It also reduced intensive care unit length of stay (ICU-LOS) (β: -2.42, p < 0.001), but increased mortality (aOR: 1.48, p = 0.029).
Among patients with isolated carotid or vertebral injuries, early CTA reduced strokes without increasing mortality. Low-grade injuries experienced reduced stroke (aOR: 0.4, p < 0.001) and shorter ICU-LOS (β: -1.77, p = 0.006). Meanwhile, high-grade injuries and resultant moderate-severe traumatic brain injury were accompanied by increases in mortality (aOR: 2.1, p < 0.001).
Finally, the team identified the following predictors of stroke: advanced age (aOR: 1.352, p = 0.047), high-grade injuries (aOR: 2.3, p < 0.001), severe injury severity score (aOR: 2.79, p < 0.001), and concomitant traumatic brain injury (aOR: 1.52, p < 0.001).
The study authors suggested that early CTA could serve as a marker of patient stability, care processes, “or other unmeasured factors that influence outcomes.”
“Prospective studies are needed to validate these findings and further establish the relationship between CTA timing and clinical outcomes to better define the role of early CTA across different BCVI subgroups,” the authors wrote.
Read the full study here.
