Traumatic vertebral artery transection injury: illustrative case

Area of Science:

• Neurosurgery
• Vascular Surgery
• Trauma Surgery

Background:

• Vertebral artery injury (VAI) is a rare complication of trauma, occurring in 0.24%-6% of cases.
• VAI can lead to severe outcomes like ischemic strokes and neurological deficits, with delayed symptom onset up to 6 months post-injury.

Purpose of the Study:

• To report a case of successful management of a complex vertebral artery injury.
• To emphasize the significance of vertebral artery reconstruction in treating severe VAI.

Main Methods:

• A 64-year-old male with a C3-4 fracture and left vertebral artery (VA) transection, pseudoaneurysm, and arteriovenous fistula underwent attempted coil embolization.
• Successful VA reconstruction was achieved via stent placement and balloon dilation.
• The patient subsequently underwent surgical decompression and fixation, followed by dual antiplatelet therapy.

Main Results:

• The patient recovered without neurological deficits and was discharged on day 13.
• In-stent stenosis, identified one year later, was successfully managed with balloon angioplasty.

Conclusions:

• Stent placement is an effective treatment for Denver scale grade V transected VAI.
• Prioritizing VA reconstruction is crucial for optimal patient outcomes in severe vertebral artery injuries.