Blunt vertebral artery injuries in the era of computed tomographic angiographic screening: incidence and outcomes from 8,292 patients

J Trauma. 2009 Dec;67(6):1333-8. doi: 10.1097/TA.0b013e31818888c7.


Introduction: Blunt injuries to the vertebral artery (BVI) are rare. Recent improvements in the multidetector computer tomography (MDCT) technology and increased use of screening protocols have led to a greater number of these injuries identified. Well-defined treatment recommendations are still lacking, and it is unclear whether screening and treatment lead to improved outcome.

Methods: All patients who met predefined screening criteria were screened for BVI with a MDCT angiogram (MDCT-A). All patients identified with BVI were treated based on injury grade and associated injuries. Hospital course, morbidity, mortality, and follow-up were recorded and analyzed.

Results: A total of 8,292 patients were admitted for blunt injuries during this time period. Forty-four patients were found to have 47 BVI (three bilateral). Pharmacologic treatment with anticoagulants (AC)-heparin and warfarin-or an antiplatelet agent-clopidogrel and aspirin-was initiated in 37 patients (84%). Angiographic coiling was performed in eight patients (18%), and two (5%) had endovascular stents placed. Four patients developed signs of cerebral ischemia (9%), of whom three died and one recovered completely. Overall mortality rate was 16% (7/44). BVI-related mortality occurred in three patients (7%). Of these, two patients had bilateral vertebral artery occlusion or transaction, and death was considered nonpreventable. One death occurred in a patient with a unilateral vertebral dissection developed a posterior circulation infarct. Anticoagulation was felt to be contraindicated in this patient initially due to intracranial hemorrhage. This was deemed the only potentially preventable BVI-related mortality. Annual BVI-related mortality rate in the 4 years before initiating the screening protocol was 0.75 cases per year. During this study period, it was 0.57 cases per year.

Conclusion: Under an aggressive screening and individualized treatment protocol for BVI, we had very few potentially preventable BVI-related strokes and deaths. We are unable to conclude; however, based on historical controls that either screening or treatment improved overall outcome.

MeSH terms

  • Anticoagulants / therapeutic use
  • Cerebral Angiography*
  • Female
  • Humans
  • Incidence
  • Male
  • Platelet Aggregation Inhibitors / therapeutic use
  • Tomography, X-Ray Computed*
  • Treatment Outcome
  • Vertebral Artery / diagnostic imaging*
  • Vertebral Artery / injuries*
  • Wounds, Nonpenetrating / diagnostic imaging*
  • Wounds, Nonpenetrating / drug therapy
  • Wounds, Nonpenetrating / epidemiology*


  • Anticoagulants
  • Platelet Aggregation Inhibitors