PC194. Follow-up Imaging of Blunt Vertebral Artery Injuries Is Unnecessary

Abstract

Routine computed tomography (CT) imaging in trauma patients has led to increased recognition of blunt vertebral artery injuries (BVI). We sought to determine the prevalence of strokes, injury progression, and need for intervention in patients with BVI. Consecutive patients presenting with BVI over two years were identified from the institutional trauma registry. Inpatient records, imaging studies and follow-up data were reviewed in detail from the electronic medical record. 76 BVI were identified in 70 patients (64% males, mean age 47 ± 19 years); bilateral injuries occurred in 6 patients. Mechanism of injury included MVC (n = 47), fall (n = 16), pedestrian motor vehicle accident (n = 2), chiropractic manipulation (n = 3), and assault (n = 2). 58 (83%) had associated C-spine fractures. 6 (8.5%) patients had CT or magnetic resonance imaging evidence of posterior circulation infarctions during admission, but only one had residual stroke symptoms after discharge. Minor (grade 1 or 2) injuries occurred in 25 patients (36%), while severe (grade 3 or 4) injuries occurred in 45 (64%). Twelve patients died of associated injuries (8 with severe BVI, 4 with minor BVI, NSD). Of the 58 surviving to discharge, 31 (53%) returned for follow-up CT scans. Six of 10 patients (60%) with minor injuries had resolution or improvement, compared with 3 of 21 patients (14%) with severe injuries (P = .027). One patient (10%) with a minor BVI and two patients (10%) with severe BVI had radiologic progression, but none were clinically significant. During a mean follow-up of 15 ± 13 months, there were no vertebral artery interventions, and there were no delayed strokes (Fig). These data suggest that BVI are relatively benign sequela of cervical trauma. BVI-related strokes present at the time of admission and do not often have clinical sequela. No late strokes occurred in this series, and no interventions were required. The majority of grade 1 and 2 injuries should be expected to improve or resolve. Regardless of severity, these data indicate that follow-up imaging of BVI is not necessary in asymptomatic patients.