Rates of healing and timing of repeat imaging after blunt cerebrovascular injury: A systematic review and meta-analysis

BACKGROUND: Blunt cerebrovascular injury (BCVI) is a nonpenetrating carotid and/or vertebral artery injury following trauma. Treatment typically involves antiplatelets or anticoagulation followed by repeat imaging. However, little is known regarding the natural history of BCVI on treatment. Therefore, we performed a systematic review and meta-analysis to summarize the healing rates at various intervals of repeat imaging. METHODS: We searched Embase and Medline from inception to November 22, 2024. We included studies reporting imaging-based follow-up outcomes of adult patients with BCVI. We organized data based on injury status and summarized overall resolution, progression, stability, and worsening of BCVI at various time points and according to injury grade. RESULTS: We included 20 studies involving 2,641 patients. Studies were predominantly retrospective in nature, originating from North America, and follow-up was primarily performed using computed tomography angiography. The median (Q1 to Q3) stroke incidence was 8.5% (5.1% to 13.1%). We demonstrate that lower-grade injury is associated with BCVI healing at follow-up imaging (pooled unadjusted odds ratio, 6.73; 95% confidence interval, 4.23-10.71, moderate certainty). In addition, we demonstrate that Grades I and II injuries demonstrated higher rates of resolution or improvement at every follow-up imaging period. CONCLUSION: This review demonstrates with moderate certainty that lower-grade BCVIs probably heal faster, while higher-grade BCVIs persist longer. These findings emphasize the importance of considering injury grade when determining the appropriate follow-up imaging interval. LEVEL OF EVIDENCE: Systematic Review and Meta-analysis; Level IV.