Blunt Traumatic Vertebral Artery Injuries: Incidence, Therapeutic Management, and Outcomes

Abstract

A single-center, retrospective review between 2011 and 2018. A total of 156 patients were treated for isolated blunt vertebral artery injuries (16 bilateral) and underwent computed tomography angiography within 24 hours of presentation. Injury location was classified as: V1 = subclavian artery origin to the entrance into the C-6 transverse foramen; V2 = within the C2-C6 transverse foramen; V3 = from the C2 foramen to the foramen magnum dura; V4 = intradural. There were 79 grade I (≤25% luminal stenosis), 39 grade II (>25% luminal stenosis), 5 grade III (pseudoaneurysm), 49 grade IV (occlusion), and 0 grade V (extravasation or arteriovenous fistula) injuries. Three strokes were detected before treatment initiation. Most patients (135) were treated with aspirin alone, 2 with heparin, and 1 with Plavix, and 18 did not receive treatment (grade I injuries or required multiple surgeries for other problems). Only two patients were switched from aspirin to anticoagulation for injury progression. No strokes were detected during hospitalization for any other patient. The risk of stroke after blunt cervical vertebral artery injury is low. Aspirin is efficacious in grade I and IV injuries, but there are limited data regarding grade II and III injuries.