4% to 56% [27–31]. However, a significant number of the recipients of this email survey were either not clinicians or are clinicians who do not see patients with TCVI. The authors received several emails AR-13324 clinical trial from recipients of the survey explaining
this. For instance, many members of the AANS are neurosurgeons who do not see trauma patients, and a number of members of the AHA Stroke Council are Ph.D.s or nurses who also do not participate in the care of patients with traumatic injury. Furthermore, the recipients of the survey who did respond may account for a significant percentage of the clinicians who actually do take care of patients with TCVI in the United States. The lowest estimated total number of TCVI cases per year seen by the respondents is 2,680. The average annual number of blunt trauma admissions from 2000 to 2004 in the United States, as tabulated by the National Trauma Data Bank, was 162,306 [32]. Therefore, the lowest estimate of TCVI cases seen annually by the survey respondents represent approximately 1.7% of the total number of blunt trauma admissions in the United
States, which is within the range of the overall incidence of TCVI (1-3%) among blunt trauma patients [1–15]. Thus, despite the seemingly low survey response rate, the respondents of this survey may represent a sizable fraction of the clinicians managing TCVI in the United States. This survey demonstrates considerable variability in all aspects of the management of patients with TCVI, from imaging to medical therapy and selleck chemicals the use of endovascular techniques. The most commonly preferred method of imaging was CTA, which likely reflects the ubiquity of CT scanning in the work-up of trauma patients, the widespread use of CTA for screening of trauma patients who are at risk of having a TCVI, and numerous published studies of CTA in this setting [14, 33–37]. However, a
significant subset of respondents (22.8%) favored MRI/MRA. This modality was most popular among neurologists, of whom 39.0% favored MRI/MRA. This may reflect current practice in the management of patients with spontaneous cervical artery dissection as expressed in a recent survey of members of the British Association of Stroke Physicians, 90% of whom indicated MRI/MRA as their preferred method Atazanavir of imaging in that setting. Overall, only 15% in the present survey preferred catheter angiography. Recently published guidelines for the management of blunt cerebrovascular injury by the Eastern Association for the Surgery of Trauma concluded that four-vessel cerebral angiography remains the gold standard for diagnosis, that duplex ultrasonography is not adequate for screening, and that multislice (eight or greater) CTA may be considered as a screening modality in place of catheter angiography[38] The authors of the guidelines also recommended that follow-up catheter angiography be done for grades I to III injuries.