Abstract
Blunt cerebrovascular injury (BCVI) is an injury that affects the cervical arteries in most cases. In the United States, BCVIs have been reported to have potentially fatal complications. Although recent reports have suggested that BCVIs occur in approximately 1% of all blunt trauma patients and that 25% of vertebral artery injuries (VAIs) and 50% of carotid artery injuries (CAIs) are associated with stroke, there is a lack of consensus on the incidence, stroke rate, and management of BCVIs in Japan because of the paucity of clinical studies. We have been applying endovascular techniques to stabilize injured arteries, and these techniques have shown a significant effect in preventing strokes. In the present report, we studied the incidence, prognosis, and significance of endovascular techniques in the management of BCVI. From October 2001 to September 2007, 1405 patients with blunt trauma were transferred to our hospital. Of these, we diagnosed 13 patients with BCVI in a total of 17 vessels. A majority of these vessels had VAIs (13 vessels with VAIs versus 4 vessels with CAIs), and morphologically, they were categorized as grades I, II, and IV (1, 7, and 9 vessels, respectively) in the Denver grading scale. Of the 13 BCVI patients, 10 (76.9%) had unstable C-spine, and of all the 25 patients with unstable C-spines, 10 (40.0%) suffered from BCVI. Ten patients received endovascular interventions along with anti-platelet therapy for a total of 11 vessels, while the remaining subjects received anti-platelet therapy alone. In the endovascular group, 9 received coil embolization for the affected vessels and 2 received carotid arterial stent (CAS) placement. The embolization group, which consisted of 6 grade IV and 3 grade II vessels, required cervical traction with halo vest brace in the acute phase. The 2 vessels that received CAS were grade II CAIs, and progressions of intimal injuries were suspected in the follow-up angiography. Restenosis of the restored vessel was not observed at 18 months of follow-up. Our results revealed that the overall incidence of cervical BCVI was 0.93%, which is similar to that of cervical BCVI in the United States; however, stroke rate was not determined in the present study. Although it is clear that anti-coagulant therapy is the gold standard treatment for BCVI, application of endovascular techniques will be effective for preventing secondary stroke in patients who require cervical traction in the acute phase or in whom anti-coagulation is prohibited because of hemorrhagic complications.
