Related Experiment Video
Updated: Oct 5, 2025
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Blunt Traumatic Vertebral Artery Injuries: Incidence, Therapeutic Management, and Outcomes
Hussein A Zeineddine1, Nicholas King, Cole T Lewis
1Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Insights
Blunt vertebral artery injury (BVAI) risk is low. Aspirin effectively prevents stroke in most BVAI cases, particularly grades I and IV, though optimal management for grades II and III requires further study.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Neurology
Background:
- Blunt cerebrovascular injury (BCVI) encompasses damage to neck arteries from blunt force trauma.
- Computed tomographic angiography is the primary screening tool for BCVI.
- Management strategies for identified arterial injuries remain undefined.
Purpose of the Study:
- To analyze a large cohort of isolated vertebral artery injuries.
- To track the progression of treated and untreated injuries.
- To assess clinical outcomes of interventions aimed at preventing stroke.
Main Methods:
- Retrospective analysis of 156 patients with isolated blunt vertebral artery injury (BVAI) at a level 1 trauma center.
- Inclusion criteria: imaging within 24 hours of presentation.
- Data collected: injury details, treatment, follow-up imaging, and stroke occurrence.
Main Results:
- 135 patients received aspirin, 3 anticoagulation, and 18 received no treatment.
- Three strokes occurred within 24 hours pre-treatment; no in-hospital strokes were observed post-treatment.
- Aspirin demonstrated efficacy in preventing stroke for grade I and IV injuries.
Conclusions:
- Stroke risk following cervical vertebral artery injury is low.
- Aspirin is an effective prophylactic treatment for grade I and IV BVAI.
- Further research is needed for grades II and III injuries and the utility of interval imaging.
Background:
Blunt 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.
Objective:
To 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.
Methods:
The 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.
Results:
A 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.
Conclusion:
Our 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.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:26Aneurysm III: Interprofessional Care
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
01:22Aneurysm IV: Nursing Management