• Hussein A Zeineddine, Nicholas King, Cole T Lewis, Matthew J Kole, Ryan Kitagawa, Mark Dannenbaum, Peng Roc Chen, Arthur L Day, and Spiros Blackburn.
• Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
• Neurosurgery. 2022 Apr 1; 90 (4): 399-406.

BackgroundBlunt cerebrovascular injury (BCVI) is a term for injuries to the carotid and vertebral arteries (blunt vertebral artery injury [BVAI]) caused by blunt trauma. Computed tomographic angiography is currently the best screening test for BCVI. The subsequent management of any identified vessel injury, however, is not clearly defined.ObjectiveTo describe one of the largest cohorts of isolated vertebral artery injuries and report the evolution of treated and untreated lesions and clinical outcomes of treatment regimens used to reduce the risk of injury-related stroke.MethodsThe list included patients who presented to or were transferred to a level 1 trauma center and found to have an isolated BVAI. Patients were included if imaging was performed within 24 hours of presentation. Data collected included location and grade of injury, timing and type of initial therapy, follow-up imaging, evolution of the disease, and associated strokes.ResultsA total of 156 patients were included in the analysis. Most patients (135/156) were treated with aspirin alone, 3 with anticoagulation therapy, and 18 did not receive treatment. Three strokes were detected within 24 hours of admission and before treatment initiation. No strokes were detected during the length of the hospitalization for any other patient.ConclusionOur data demonstrate that the risk of stroke after cervical vertebral artery injury is low, and aspirin as a prophylactic is efficacious in grade I and IV injuries. There are limited data regarding grade II and grade III injuries. The benefit of early interval imaging follow-up is unclear and warrants investigation.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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