BCVIs (Blunt Cerebrovascular Injury) will not be visualised on plain CT scans unless contrast is specifically requested. Up to 20% will be missed, with stroke being the most devastating consequence.

Extended Denver criteria

See extended Denver criteria for blunt cervical vascular injury.

Grades of injury

  • Grade I (intimal injury <25% narrowing)
  • Grade II (dissection or intramural haematoma >25%)
  • Grade III (pseudoaneurysm)
  • Grade IV (occlusion)
  • Grade V (transection with extravasation).

Management

  • Surgery is indicated for Grade II, III, IV & V injuries that are surgically accessible
  • Endovascular treatment for Grade V injuries that are not surgically accessible
  • Treat Grade I injuries and Grade II, III, IV and V injuries not undergoing surgical intervention with Aspirin (or heparin) and repeat CTA in 7-10 days
  • If Repeat CTA shows a healed injury stop treatment otherwise continue treatment for 3-6 months and re-image.