Detecting traumatic internal carotid artery dissection using transcranial Doppler in head-injured patients

• Published in: Intensive care medicine Vol. 36; no. 9; pp. 1514 - 1520
• Main Authors: Bouzat, Pierre, Francony, Gilles, Brun, Julien, Lavagne, Pierre, Picard, Julien, Broux, Christophe, Declety, Philippe, Jacquot, Claude, Albaladejo, Pierre, Payen, Jean-Francois
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.09.2010; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Brain; Brain damage; Brain Injuries - complications; Brain Injuries - diagnostic imaging; Carotid Artery Diseases - diagnostic imaging; Carotid Artery, Internal, Dissection - diagnostic imaging; Carotid Artery, Internal, Dissection - etiology; Case-Control Studies; Cohort Studies; Critical Care Medicine; CT imaging; Emergency Medicine; Female; Humans; Injuries; Intensive; Intensive care medicine; Male; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - pathology; Neurology; Original; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Pulsatile Flow; Retrospective Studies; Risk Factors; Surgery; Trauma Severity Indices; Ultrasonography, Doppler, Transcranial - methods; Ultrasonography, Interventional; Vascular diseases and vascular malformations of the nervous system; Young Adult; France; Carotid dissection; Internal carotid; Transcranial Doppler; Trauma; Sonography; Doppler ultrasound study; Human; Nervous system diseases; Intensive care; Cardiovascular disease; Cerebral disorder; Arterial disease; Vascular disease; Central nervous system disease; Carotid dissecting aneurysm; Head trauma; Cerebrovascular disease; Resuscitation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-010-1919-0

Purpose The early diagnosis of traumatic internal carotid artery dissection (TICAD) is essential for initiating appropriate treatment and improving outcome. We searched for criteria from transcranial Doppler (TCD) measurements on admission that could be associated with subsequent TICAD diagnosis in patients with traumatic brain injury (TBI). Methods We conducted a retrospective 1:4 matched (age, mean arterial blood pressure) cohort study of 11 TBI patients with TICAD and absent or mild brain lesions on initial CT scan, 22 TBI controls with comparable brain CT scan lesions (controls 1), and 22 TBI controls with more severe brain CT scan lesions (controls 2) on admission. TCD measurements were obtained on admission from both middle cerebral arteries (MCA). All patients had subsequent CT angiography to diagnose TICAD. Results A >25% asymmetry in the systolic blood flow velocity between the two MCA was found in 9/11 patients with TICAD versus 0/22 in controls 1 and 5/22 in controls 2 ( p  < 0.01). The combination of this asymmetry with an ipsilateral pulsatility index ≤0.80 was found in 9/11 patients with TICAD versus none in the two groups of controls ( p  < 0.01). Conclusions Our results suggest that significant asymmetry in the systolic blood flow velocity between the MCAs and a reduced ipsilateral pulsatility index could be criteria from TCD measurements associated with the occurrence of TICAD in head-injured patients. If prospectively validated, these findings could be incorporated in screening protocols for TICAD in patients with TBI.