Traumatic Vertebral Artery Injury: Diagnosis, Natural History, and Key Considerations for Management

Area of Science:

• Neuroscience
• Trauma Surgery
• Vascular Surgery

Background:

• Vertebral artery injury (VAI) is a recognized complication of blunt cervical spine trauma.
• Associated factors include cervical bony injury, spinal cord injury, and overall trauma severity.
• There is a lack of consensus on VAI screening, diagnosis, and management.

Purpose of the Study:

• To review the pathophysiology and natural history of VAI.
• To summarize current data on VAI screening and diagnosis.
• To explore medical and endovascular management strategies for VAI.

Main Methods:

• Comprehensive narrative review of the latest evidence.
• Synthesis of data on VAI and associated ischemic sequelae.
• Analysis of findings from a previous systematic review and meta-analysis on VAI recanalization.

Main Results:

• VAI carries a significant risk of stroke.
• Vertebral artery occlusion can be dynamic, with notable recanalization rates.
• Treatment with anticoagulant and/or antiplatelet therapy (ACAP) is standard but complicated by co-existing injuries.

Conclusions:

• Understanding VAI pathophysiology and natural history is crucial.
• Current screening, diagnostic, and therapeutic strategies require further elucidation.
• Management necessitates careful consideration of patient-specific factors and potential complications.