Treatment of Traumatic Blunt Vertebral Artery Injuries: Teikyo University Experience

Abstract

Objectives: Traumatic vertebral artery injury (VAI) is a rare condition. We report 3 cases of VAI requiring therapeutic interventions, which were successfully treated with medical or endovascular treatments.

Case Presentations: Case 1: A 42-year-old man had a cervical vertebral fracture (the 6th cervical spine) and severe stenosis of the right vertebral artery at the same level of the cervical fracture. He was conservatively treated with antiplatelet therapy.

Case 2: A 68-year-old woman suffered from cervical fracture at the 2nd cervical spine, and vertebral artery occlusion was found at the same cervical level of the fracture. We prescribed the same therapeutic protocol as Case 1, and she was treated conservatively with antiplatelet therapy.

Case 3: A 38-year-old male had a fracture of the cervical spine (the third to sixth cervical spines). His CT disclosed the fracture with occlusion of vertebral artery. While this patient required surgical fixation for the cervical fracture, endovascular coil embolization of the left vertebral artery was performed to prevent unexpected bleeding during the spinal surgery and distal cerebral thrombosis on recanalization of the occluded vertebral artery.

Conclusion: In all the 3 cases, VAIs were diagnosed before they complicated serious neurological deficits and were adequately treated. In cases of cervical trauma, possibility of VAI had to be always considered and we should readily diagnose and adequately treat it with medical or endovascular interventions.