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Blunt cerebrovascular injury: Treatment and outcomes

Authors
Walter L Biffl, MD
Clay Cothren Burlew, MD
Ernest E Moore, MD
Section Editors
Eileen M Bulger, MD, FACS
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Blunt carotid and vertebral artery injuries, collectively termed blunt cerebrovascular injury, are uncommon but potentially devastating events. The incidence of blunt cerebrovascular injury in patients sustaining blunt trauma is about 1 percent [1,2]. Untreated blunt carotid injury is associated with mortality rates that range from 23 to 28 percent, with 48 to 58 percent of survivors suffering permanent severe neurologic deficits [3,4].

Given the high morbidity and mortality rates associated with untreated blunt cerebrovascular injury, expectant management is not appropriate unless there are contraindications to treatment. Treatment strategies include antithrombotic therapy, surgical repair, and endovascular intervention. The treatment strategy for a given individual depends upon their symptoms, site of injury, severity or grade of injury, associated injuries that may complicate treatment, and local expertise [1].

The treatment and outcomes of blunt cerebrovascular injury are reviewed. The injury mechanisms, screening, and diagnosis of blunt cerebrovascular injury are reviewed elsewhere. (See "Blunt cerebrovascular injury: Mechanisms, screening, and diagnostic evaluation".)

Penetrating cerebrovascular injury and spontaneous cerebrovascular dissection are discussed elsewhere. (See "Penetrating neck injuries: Initial evaluation and management" and "Spontaneous cerebral and cervical artery dissection: Clinical features and diagnosis".)

INJURY GRADING

A grading scale for blunt cerebrovascular injury was created to standardize clinical communication and to guide therapy [5]. For the carotid artery, stroke rates increase with increasing injury grade [5]. Stroke incidence and neurologic outcome for vertebral injury are independent of injury grade. In a study of 171 patients found to have 236 blunt cerebrovascular injuries, the distribution of injury is representative: grade I (58 percent), grade II (22 percent), grade III (14 percent), grade IV (11 percent), and grade V (3 percent) [1].

                   

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Literature review current through: Nov 2016. | This topic last updated: Mon Jul 18 00:00:00 GMT 2016.
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