Document resource
Introduction Blunt cerebrovascular injuries (BCVIs) are a potentially devastating complication that can arise in blunt trauma and have been shown to increase the risk of stroke and mortality. Transcranial Doppler (TCD) is a common method for assessing stroke risk by detecting positive microembolic signals (MES) over time in patients with BCVI injuries. Prior studies have shown that a higher embolic burden is associated with increased stroke risk. However, it is unclear the role of TCD-guided escalation of antithrombotic therapy in reducing stroke risk and incidence.Methods We performed a retrospective analysis on 85 patients who suffered a BCVI injury and were evaluated with TCD between June 2021 and April 2025. Patient analysis was restricted to those with positive MES during TCD monitoring (MES+; n=30) and then categorized based on whether medical management was upgraded with therapeutic anticoagulation initiated after TCD findings (n=9) or whether medical management was not changed following TCD. Our primary outcome was post-treatment stroke. Secondary outcomes included pre-treatment strokes, inpatient mortality, and functional outcomes at follow-up using the Glasgow Outcome Scale-Extended (GOS-E). Analysis between groups was performed using Fisher’s exact test and the Wilcoxon signed-rank test.Results We evaluated 85 patients with BCVI who received TCD monitoring after hospital admission to a single institution. In our study population, 64.7% were male with a median age of 42. Overall, there was no significant difference in presenting GCS, injury severity score, Marshall score, or BCVI grade between those with positive vs negative MES on TCD. Patients with MES+ had a higher incidence of stroke both pre- and post-antithrombotic intervention compared to MES- (OR 6.98, 95% CI 1.61–37.04; p = 0.0035). Of the 30 MES+ patients, stroke incidence was not significantly different between those whose medical management was upgraded after positive emboli signals were detected, compared to those whose medical management did not change (Fisher’s exact p=1.00; OR 0.62). Additionally, between the two groups, there was no significant difference between in-patient mortality (OR 1.68, 95% CI 0.12–18.31; p=0.622) or functional outcome measured by follow-up GOS-E (W = 21.5, p = 0.52).Conclusion Our results are consistent with prior literature supporting the use of TCD for risk identification of patients at increased risk of stroke. However, in our study, patients whose medical therapy was upgraded after a positive MES on TCD did not differ significantly from those managed without TCD. These early findings may suggest that while MES is a strong predictor of stroke, the clinical utility of using MES as a metric to guide management remains unclear. Due to the nature of our data, this study was limited by sample size and stroke rates, which could reduce statistical power between groups.Disclosures M. Rager: None. P. Bi: None. D. Nistal: None. R. Bonow: None. S. Chen: None.