SAVS Main Site  |  Past and Future Meetings
Southern Association For Vascular Surgery

Back to 2020 Abstracts


Current Outcomes of Blunt Vertebral Artery Injuries
Andrew Sticco, Sagar Ghandi, Bryan Knoedler, Geoff Marston, Alex Ewing, Gene Langan, III, Christopher Carsten, III
Prisma Health, Greenville, SC

Current Outcomes of Blunt Vertebral Artery Injuries
Objective: There is no consensus on the treatment of blunt vertebral artery injuries and studies are limited to small case series. We assessed the natural history and current management of these injuries.
Methods: We performed a retrospective study of a prospectively collected registry at a level I trauma center over a five year period. Additional information was gathered from patient charts and imaging review from electronic medical records. We analyzed demographics, mechanism of injury, GCS, mortality, length of stay, associated injuries, Denver grading scale, neurological findings, level and laterality of injury, delay in diagnosis, treatment, and follow-up imaging.
Results: There were 13,080 trauma admissions during this time period yielding 141 patients with blunt vertebral artery injuries from 2013 to 2018 (1.0% incidence). Mean injury severity scale was 22.5 with a 30 day mortality of 14 (9.9%). There were 112 (79.4%) associated cervical fractures. C6 and C7 were both equally the most common locations for fractures occurring 44 times each (31.2%). There was one symptomatic injury manifesting as a cerebellar ischemic infarct. There were 61 (43.3%) instances of Denver grade I injuries, followed by grade IV at 36 (25.5%), grade II at 34 (24.1%), grade III at 8 (5.7%), and grade V at 1 (0.7%). The level of injury was recorded as follows; V2 = 67 (47.5%), V3 = 56 (39.7%), V1 = 48 (34%), V4 = 14 (9.9%). Medical therapy included aspirin in 93 (66%) patients, 31 (22%) patients received systemic anticoagulation with heparin drip, and 2 (1%) patients were administered therapeutic Lovenox. 15 patients (10%) received no medical treatment. There was one intervention in our series. Our only grade V injury was coil embolized. 118 (84%) patients had follow-up imaging. 78 (96%) grade I and grade II injuries did not worsen and complete radiographic resolution was found in 50 (62%) patients. Grade IV injuries persisted in 22 (75.9%) patients. Median time to resolution for grade I and grade II injuries was 7 and 8 days respectively. Most follow-up scans for grade I and II injuries occurred within 50 days.
Conclusions: Posterior circulation stroke due to blunt vertebral artery injury is rare. In our experience, the natural course of blunt vertebral artery injury was benign and neither delay in medical treatment or choice of antithrombotic had a significant impact on outcomes. In our series, only 3 (3.7%) grade I and II injuries worsened and were without any clinical sequela. We suggest that routine serial imaging in grade I and II blunt vertebral injuries is not warranted.


Back to 2020 Abstracts