• Mustafa Motiwala, Vincent N Nguyen, Taylor Orr, Kara A Parikh, Lindsey Erin Miller, Michael Barats, Jordan T Roach, Sean Himel, Bhageeradh Mulpur, Nicolas K Khattar, Andrew J Kerwin, Martin Croce, Adam Arthur, Violiza Inoa-Acosta, Christopher Nickele, Daniel Hoit, Lucas Elijovich, Nitin Goyal, and Nickalus R Khan.
• Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
• Neurosurgery. 2024 May 20.

Background And ObjectivesThe management of blunt cerebrovascular injuries (BCVIs) remains an important topic within trauma and neurosurgery today. There remains a lack of consensus within the literature and significant variation across institutions. The purpose of this study was to evaluate management of BCVI at a large, tertiary referral trauma center.MethodsInstitutional Review Board approval was obtained to conduct a retrospective review of patients with BCVI at our Level 1 Trauma Center. Computed tomography angiography was used to identify BCVI for each patient. Patient information was collected, and statistical analysis was performed. With the included risk factors for ischemic complications, a novel scoring system based on ischemic risk, the "Memphis Score," was developed and evaluated to grade BCVI.ResultsTwo hundred seventeen patients with BCVI from July 2020 to August 2022 were identified. The most common mechanism of injury was motor vehicle collision (141, 65.0%). Vertebral arteries were the most common vessel injured (136, 51.1%) with most injuries occurring at a high cervical location (101, 38.0%). Denver Grade 1 injuries (89, 33.5%) and a Memphis Score of 1 were most frequent (172, 64.6%), and initial anticoagulation with heparin drip was initiated 56.7% of the time (123). Endovascular treatment was required in 24 patients (11.1%) and was usually performed in the first 48 hours (15, 62.5%). While Denver Grade (P = .019) and Memphis Score (P < .00001) were significantly higher in those patients undergoing endovascular treatment, only the Memphis Score demonstrated a significant difference between those patients who had stroke or worsening on follow-up imaging and those who did not (P = .0009).ConclusionAlthough BCVI management has improved since early investigative efforts, institutions must evaluate and share their data to help clarify outcomes. The novel "Memphis Score" presents a standardized framework to communicate ischemic risk and guide management of BCVI.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

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