Transcranial Doppler Monitoring of Carotid and Vertebral Artery Injuries at a Level I Trauma Center

Jason Chang, MD1, Louis Kim, MD1, Kathleen Fink, MD1, Manuel Ferreira, MD, PhD1, Randall Chesnut, MD1

1Seattle, WA United States

Keywords: vertebral artery, blood flow, trauma, doppler, carotid artery

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     To define any relationship between dynamic microemboli monitoring and vascular irregularities graded according to the Biffl injury scale.
     Of these 46 patients there were 16 (Biffl I), 14 (II), 2 (III), 11 (IV), and 3 patients who did not have any arterial injury by CTA.
     Retrospective review of patients admitted from 2006 – 2010. Suspected vascular injuries were identified by CTA were monitored for 3 days with TCDs for hyperechoic material distal to the injury.
     2740 CTAs were performed according to established protocols to screen for vascular irregularities. 809 (30%) patients received TCDs with microemboli monitoring for 3 days. 5.7% (46) of those monitored were positive for microemboli. 67% (31) were on antiplatelet or anticoagulant during the monitoring. Hourly microemboli ranged from 0 – 67. The mean ± SD was 3 ± 7 microemboli. Although 54% (25) of these patients positive for microemboli had cervical spine fractures extending into the transverse foramen, no strong association was observed in proportion to microemboli. Five patients presented with posterior circulation infarcts. The mean ± SD for this subgroup was 10 ± 17 microemboli. Two were diagnosed on MR imaging within a week from the initial CTA. None required surgical decompression.
     This is a retrospective study.  
     Carotid and vertebral artery irregularities detected by CTA in the setting of trauma followed for three days with TCDs can be associated with microemboli in a small percentage of patients.
     TCDs may be a useful tool to guide medical management in the prevention of associated infarcts.


Project Roles:

J. Chang (), L. Kim (), K. Fink (), M. Ferreira (), R. Chesnut ()