Cerebrovascular Injury Management in Blunt Trauma

Blunt trauma to the head and neck can give rise to a spectrum of vascular injuries affecting the carotid and vertebral arteries, collectively termed blunt cerebrovascular injury (BCVI). Although historically regarded as rare, improvements in imaging now reveal incidences as high as 1–2 per cent of all major blunt trauma cases and up to 9 per cent in severe head injuries. The clinical presentation may range from asymptomatic vessel dissection to frank ischaemic stroke, pseudoaneurysm formation or arteriovenous fistula. Early recognition and stratification of injury severity—using grading scales such as the Denver or Biffl classification—are critical in guiding management. Screening protocols typically employ computed tomography angiography (CTA) guided by clinical and radiological risk factors, though recent work suggests broader criteria may capture more at-risk patients. Management strategies span medical therapy with antithrombotic or antiplatelet agents, endovascular intervention using stents or embolic devices, and, less commonly, open surgical repair. The choice of treatment is influenced by lesion grade, patient comorbidities and associated injuries. A multidisciplinary approach involving trauma surgeons, neurointerventionalists and neurologists is essential in balancing the risks of haemorrhage against stroke prevention, optimising timing of therapy and planning longitudinal imaging follow-up. Long-term outcomes vary with injury severity and treatment modality, but functional impairments following ischaemic events remain a major concern for survivors.

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Cerebrovascular Injury Management in Blunt Trauma publication trend

The graph below shows the total number of articles in cerebrovascular injury management in blunt trauma across all publications each year (not limited to Nature Index journals).

Technical terms

Blunt cerebrovascular injury (BCVI): Non-penetrating trauma to the carotid or vertebral arteries leading to dissection, occlusion, pseudoaneurysm or fistula formation.

Computed tomography angiography (CTA): High-resolution imaging technique that visualises blood vessels following intravenous contrast injection, essential for BCVI screening.

Denver screening criteria: Clinical and radiological risk-factor checklist guiding selective CTA to detect BCVI.

Pseudoaneurysm: False aneurysm arising from vessel wall disruption, contained by surrounding tissues rather than all arterial wall layers.

Endovascular therapy: Minimally invasive procedures performed within the vessel lumen using catheters, stents or embolic materials to repair or occlude vascular lesions.

References

1. Neuroendovascular Surgery Applications in Craniocervical Trauma. Biomedicines (2023).
2. Best practice guidelines for blunt cerebrovascular injury (BCVI). Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2018).
3. Blunt Cerebrovascular Injuries: Advances in Screening, Imaging, and Management Trends. American Journal of Neuroradiology (2017).
4. Blunt cerebrovascular injury: incidence and long-term follow-up. European Journal of Trauma and Emergency Surgery (2019).
5. Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke. Emergency Radiology (2019).