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Blunt Cerebrovascular Injuries (BCVIs): Morphological Insights Into Grade III Injuries
Stephen A Iacono1, Eryn Beal1, Maggie Sundel1
1R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA.
The American Surgeon
|July 29, 2026
Summary
Complex blunt cerebrovascular injuries (BCVIs) show greater vessel enlargement and narrowing, indicating a higher risk for stroke. Injury morphology is crucial for BCVI risk stratification.
Area of Science:
- Vascular Surgery
- Neuroradiology
- Trauma Surgery
Background:
- Blunt cerebrovascular injuries (BCVIs) are associated with significant stroke risk.
- Current guidelines lack morphology-specific risk stratification for BCVIs.
- Grade III pseudoaneurysms, characterized by focal wall disruption, require further investigation.
Purpose of the Study:
- To characterize morphologic subtypes of grade III BCVI.
- To evaluate the vascular impact of different grade III BCVI morphologies.
- To assess the role of morphology in BCVI risk stratification.
Main Methods:
- Retrospective review of 31 patients with grade III BCVI diagnosed via CT angiography.
- Exclusion of penetrating trauma and lower-grade injuries.
- Characterization of lesions by location, morphology (saccular, fusiform, complex), vessel diameter, luminal compromise, and intimal flaps.
Main Results:
- Complex BCVI morphologies showed significantly greater maximal vessel enlargement (180%) compared to saccular (150%) and fusiform (140%).
- Luminal compromise was highest in complex (75%) and fusiform irregular (65%) lesions.
- Saccular lesions most commonly resulted in mild luminal compromise (1-50%).
Conclusions:
- Morphologic subtypes of grade III BCVI exhibit distinct vascular characteristics.
- Complex BCVI morphologies are associated with increased vessel enlargement and luminal narrowing.
- Injury morphology may play a critical role in stratifying thrombotic complication risk for BCVIs.
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