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Traumatic vertebral artery injuries
Traumatic vertebral artery injuries refer to damages to the vertebral artery, a major artery in the neck, due to trauma.
The pathophysiology of traumatic vertebral artery injuries involves three primary mechanisms: intimal tears, dissections, and pseudoaneurysms. Most traumatic vertebral artery injuries are limited to an intimal dissection, which is a tear in the innermost layer of the artery. However, in rare cases, the artery can be completely transected, leading to extravasation of hemorrhage into the surrounding soft tissues of the neck.
The incidence of cervical trauma is estimated at 10.5 per 100,000 person-years worldwide. The incidence of vertebral artery injuries in patients with cervical spine fractures is reported to be as high as 30%.
Traumatic vertebral artery injuries can present with a variety of clinical manifestations. These can range from non-specific symptoms such as dizziness, headache, and neck pain, to more severe complications like posterior circulation stroke.
Prognosis and risk of recurrence
The prognosis of these injuries can vary widely and is largely dependent on early detection and prompt treatment. However, even with timely intervention, the outcome can still be influenced by the extent of the injury and associated complications.
The following summarized guidelines for the evaluation and management of traumatic vertebral artery injuries are prepared by our editorial team based on guidelines from the American Association of Neurological Surgeons (AANS/CNS 2013).
1.Screening and diagnosis
Indications for testing: screen for traumatic vertebral artery injuries in selected patients with blunt cervical trauma who meet the modified Denver Screening Criteria for suspected vertebral artery injury.
Computed tomography angiography: obtain CTA as a screening tool in selected patients after blunt cervical trauma who meet the modified Denver Screening Criteria for suspected vertebral artery injury.
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Antithrombotic therapy: individualize the choice of antithrombotic therapy (anticoagulation therapy, antiplatelet therapy or no treatment) based on the patient's vertebral artery injury, the associated injuries, and the risk of bleeding.
Endovascular therapy: insufficient evidence to make a recommendation regarding the use of endovascular therapy in the treatment of vertebral artery injury.