Lethal now or lethal later: The natural history of Grade 4 blunt XXXX .

@entity1 @entity64 @entity6455 @entity130
BACKGROUND: Grade 4 blunt @entity130 (BCVI4) has a known, significant rate of @entity64 . However, little is known about the natural history of BCVI4 and the pathophysiology of subsequent @entity64 formation. METHODS: A 4-year review of @entity1 with BCVI4 at the R Adams @entity130 Center was performed. Rates of BCVI4-related @entity64 , @entity64 -related mortality, and overall mortality were calculated. The relationship of change in vessel characteristics and BCVI4-related @entity64 was examined, as was the mechanism of @entity64 formation. RESULTS: There were 82 BCVI4s identified, with 13 carotid artery (ICA) and 69 vertebral artery BCVI4s. BCVI4-related @entity64 rate was 2.9% in vertebral artery BCVI4 and 70% in ICA BCVI4 @entity1 surviving to reimaging. @entity64 mechanisms included @entity64 , @entity64 , and combined embolic and @entity64 . Peristroke vessel recanalization and an @entity64 mechanism were seen in 100% of @entity6455 BCVI4-related @entity64 developing after admission. BCVI4-related @entity64 occurred within 10 hours of hospital admission in 67% of the @entity1 with @entity64 . Contraindications to anticoagulation were present in most @entity1 with BCVI4-related @entity64 developing after admission. CONCLUSION: Multiple etiologies of @entity64 formation exist in BCVI4. Early risk-benefit analysis for initiation of anticoagulation or antiplatelet agents should be performed in all @entity1 with BCVI4, and the use of endovascular vessel occlusion should be considered in those with true contraindications to anticoagulation. However, more aggressive medical therapy may be needed to lessen BCVI4-related @entity64 development. LEVEL OF EVIDENCE: Prognostic study, level IV; therapeutic study, level V.
