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Management of Blunt Cerebrovascular Injury

  • Stroke (H Diener, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review provides an updated summary of blunt cerebrovascular injury (BCVI) to guide clinicians in its early diagnosis and prevention and treatment of stroke associated with such injury.

Recent Findings

Untreated BCVI causes stroke in 10–40% of patients, but more than half will not present with stroke symptoms initially. Risk of stroke is highest in the first 7 days, with a peak in the first 24 h. Computed tomography (CT) angiography is currently the screening modality of choice, although digital subtraction angiography may still be required in some cases. Antithrombotic therapy is the mainstay of treatment and has proven safety in trauma patients. In carefully selected patients, endovascular intervention may also be beneficial.

Summary

BCVI is a potentially preventable cause of stroke. A high index of suspicion is needed as emergent screening during initial evaluation can provide a window for stroke prevention. Screening all patients with injuries that would otherwise prompt CT scans of the neck or chest is recommended. Treatment is guided by grade of injury. Early treatment with antithrombotics has been shown to be both effective and safe.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Weber CD, Lefering R, Kobbe P, Horst K, Pishnamaz M, Sellei RM, et al. Blunt cerebrovascular artery injury and stroke in severely injured patients: an international multicenter analysis. World J Surg. 2018;42(7):2043–53. https://doi.org/10.1007/s00268-017-4408-6.

    Article  PubMed  Google Scholar 

  2. Stein DM, Boswell S, Sliker CW, Lui FY, Scalea TM. Blunt cerebrovascular injuries: does treatment always matter? J Trauma. 2009;66(1):132–43; discussion 43-4. https://doi.org/10.1097/TA.0b013e318142d146.

    Article  PubMed  Google Scholar 

  3. Biffl WL, Ray CE, Moore EE, Franciose RJ, Aly S, Heyrosa MG, et al. Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg. 2002;235(5):699–706 discussion −7.

    Article  Google Scholar 

  4. Edwards NM, Fabian TC, Claridge JA, Timmons SD, Fischer PE, Croce MA. Antithrombotic therapy and endovascular stents are effective treatment for blunt carotid injuries: results from longterm followup. J Am Coll Surg. 2007;204(5):1007–13; discussion 14-5. https://doi.org/10.1016/j.jamcollsurg.2006.12.041.

    Article  PubMed  Google Scholar 

  5. Bromberg WJ, Collier BC, Diebel LN, Dwyer KM, Holevar MR, Jacobs DG, et al. Blunt cerebrovascular injury practice management guidelines: the eastern Association for the Surgery of Trauma. J Trauma. 2010;68(2):471–7. https://doi.org/10.1097/TA.0b013e3181cb43da.

    Article  PubMed  Google Scholar 

  6. Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Burch JM. Blunt carotid arterial injuries: implications of a new grading scale. J Trauma. 1999;47(5):845–53.

    Article  CAS  Google Scholar 

  7. Franz RW, Willette PA, Wood MJ, Wright ML, Hartman JF. A systematic review and meta-analysis of diagnostic screening criteria for blunt cerebrovascular injuries. J Am Coll Surg. 2012;214(3):313–27. https://doi.org/10.1016/j.jamcollsurg.2011.11.012.

    Article  PubMed  Google Scholar 

  8. •• Geddes AE, Burlew CC, Wagenaar AE, Biffl WL, Johnson JL, Pieracci FM, et al. Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated. Am J Surg. 2016;212(6):1167–74. https://doi.org/10.1016/j.amjsurg.2016.09.016. This study demonstrates the improved sensitivity of identification of BCVI following adoption of expanded criteria and also provides a flowchart with BCVI screening guidelines for reference.

    Article  PubMed  Google Scholar 

  9. Burlew CC, Sumislawski JJ, Behnfield CD, McNutt MK, McCarthy J, Sharpe JP, et al. Time to stroke: a Western Trauma Association multi-center study of BLUNT cerebrovascular injuries. J Trauma Acute Care Surg. 2018:1. https://doi.org/10.1097/TA.0000000000001989.

    Article  Google Scholar 

  10. Kennell KA, Daghfal MM, Patel SG, DeSanto JR, Waterman GS, Bertino RE. Cervical artery dissection related to chiropractic manipulation: one institution’s experience. J Fam Pract. 2017;66(9):556–62.

    PubMed  Google Scholar 

  11. Paulus JK, Thaler DE. Does case misclassification threaten the validity of studies investigating the relationship between neck manipulation and vertebral artery dissection stroke? Yes. Chiropr Man Therap. 2016;24:42. https://doi.org/10.1186/s12998-016-0123-x.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Biller J, Sacco RL, Albuquerque FC, Demaerschalk BM, Fayad P, Long PH, et al. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(10):3155–74. https://doi.org/10.1161/STR.0000000000000016.

    Article  CAS  PubMed  Google Scholar 

  13. Paulus EM, Fabian TC, Savage SA, Zarzaur BL, Botta V, Dutton W, et al. Blunt cerebrovascular injury screening with 64-channel multidetector computed tomography: more slices finally cut it. J Trauma Acute Care Surg. 2014;76(2):279–83; discussion 84-5. https://doi.org/10.1097/TA.0000000000000101.

    Article  PubMed  Google Scholar 

  14. Fabian TC, Patton JH, Croce MA, Minard G, Kudsk KA, Pritchard FE. Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy. Ann Surg. 1996;223(5):513–22 discussion 22-5.

    Article  CAS  Google Scholar 

  15. • Shahan CP, Croce MA, Fabian TC, Magnotti LJ. Impact of Continuous Evaluation of Technology and Therapy: 30 Years of Research Reduces Stroke and Mortality from Blunt Cerebrovascular Injury. J Am Coll Surg. 2017;224(4):595–9. This reports the dramatic reduction in stroke and mortality seen with increased screening protocols. https://doi.org/10.1016/j.jamcollsurg.2016.12.008.

    Article  PubMed  Google Scholar 

  16. Cothren CC, Moore EE, Ray CE, Ciesla DJ, Johnson JL, Moore JB, et al. Screening for blunt cerebrovascular injuries is cost-effective. Am J Surg. 2005;190(6):845–9. https://doi.org/10.1016/j.amjsurg.2005.08.007.

    Article  PubMed  Google Scholar 

  17. Cothren CC, Biffl WL, Moore EE, Kashuk JL, Johnson JL. Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents. Arch Surg. 2009;144(7):685–90. https://doi.org/10.1001/archsurg.2009.111.

    Article  CAS  PubMed  Google Scholar 

  18. Burlew CC, Biffl WL, Moore EE, Barnett CC, Johnson JL, Bensard DD. Blunt cerebrovascular injuries: redefining screening criteria in the era of noninvasive diagnosis. J Trauma Acute Care Surg. 2012;72(2):330–5; discussion 6-7, quiz 539. https://doi.org/10.1097/TA.0b013e31823de8a0.

    Article  PubMed  Google Scholar 

  19. Fabian TC, George SM, Croce MA, Mangiante EC, Voeller GR, Kudsk KA. Carotid artery trauma: management based on mechanism of injury. J Trauma. 1990;30(8):953–61 discussion 61-3.

    Article  CAS  Google Scholar 

  20. Berne JD, Norwood SH, McAuley CE, Vallina VL, Creath RG, McLarty J. The high morbidity of blunt cerebrovascular injury in an unscreened population: more evidence of the need for mandatory screening protocols. J Am Coll Surg. 2001;192(3):314–21.

    Article  CAS  Google Scholar 

  21. Cogbill TH, Moore EE, Meissner M, Fischer RP, Hoyt DB, Morris JA, et al. The spectrum of blunt injury to the carotid artery: a multicenter perspective. J Trauma. 1994;37(3):473–9.

    Article  CAS  Google Scholar 

  22. Cothren CC, Moore EE, Biffl WL, Ciesla DJ, Ray CE, Johnson JL, et al. Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg. 2004;139(5):540–5; discussion 5-6. https://doi.org/10.1001/archsurg.139.5.540.

    Article  PubMed  Google Scholar 

  23. Miller PR, Fabian TC, Bee TK, Timmons S, Chamsuddin A, Finkle R, et al. Blunt cerebrovascular injuries: diagnosis and treatment. J Trauma. 2001;51(2):279–85 discussion 85-6.

    Article  CAS  Google Scholar 

  24. Ciapetti M, Circelli A, Zagli G, Migliaccio ML, Spina R, Alessi A, et al. Diagnosis of carotid arterial injury in major trauma using a modification of Memphis criteria. Scand J Trauma Resusc Emerg Med. 2010;18:61. https://doi.org/10.1186/1757-7241-18-61.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Elliott JP, et al. Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 1999;178(6):517–22.

    Article  CAS  Google Scholar 

  26. Lebl DR, Bono CM, Velmahos G, Metkar U, Nguyen J, Harris MB. Vertebral artery injury associated with blunt cervical spine trauma: a multivariate regression analysis. Spine (Phila Pa 1976). 2013;38(16):1352–61. https://doi.org/10.1097/BRS.0b013e318294bacb.

    Article  Google Scholar 

  27. Biffl WL, Moore EE, Elliott JP, Ray C, Offner PJ, Franciose RJ, et al. The devastating potential of blunt vertebral arterial injuries. Ann Surg. 2000;231(5):672–81.

    Article  CAS  Google Scholar 

  28. Kopelman TR, Leeds S, Berardoni NE, O'Neill PJ, Hedayati P, Vail SJ, et al. Incidence of blunt cerebrovascular injury in low-risk cervical spine fractures. Am J Surg. 2011;202(6):684–8; discussion 8-9. https://doi.org/10.1016/j.amjsurg.2011.06.033.

    Article  PubMed  Google Scholar 

  29. Wei CW, Montanera W, Selchen D, Lian J, Stevens C, de Tilly LN. Blunt cerebrovascular injuries: diagnosis and management outcomes. Can J Neurol Sci. 2010;37(5):574–9.

    Article  Google Scholar 

  30. Beliaev AM, Civil I. Asymptomatic carotid blunt cerebrovascular injury: a new screening criterion. ANZ J Surg. 2014;84(6):491–2. https://doi.org/10.1111/ans.12314.

    Article  PubMed  Google Scholar 

  31. Biffl WL, Cothren CC, Moore EE, Kozar R, Cocanour C, Davis JW, et al. Western Trauma Association critical decisions in trauma: screening for and treatment of blunt cerebrovascular injuries. J Trauma. 2009;67(6):1150–3. https://doi.org/10.1097/TA.0b013e3181c1c1d6.

    Article  PubMed  Google Scholar 

  32. Wu X, Malhotra A, Forman HP, Nunez D, Sanelli P. The use of high-risk criteria in screening patients for blunt cerebrovascular injury: a survey. Acad Radiol. 2017;24(4):456–61. https://doi.org/10.1016/j.acra.2016.11.010.

    Article  PubMed  Google Scholar 

  33. Jacobson LE, Ziemba-Davis M, Herrera AJ. The limitations of using risk factors to screen for blunt cerebrovascular injuries: the harder you look, the more you find. World J Emerg Surg. 2015;10:46. https://doi.org/10.1186/s13017-015-0040-7.

    Article  PubMed  PubMed Central  Google Scholar 

  34. •• Bruns BR, Tesoriero R, Kufera J, Sliker C, Laser A, Scalea TM, et al. Blunt cerebrovascular injury screening guidelines: what are we willing to miss? J Trauma Acute Care Surg. 2014;76(3):691–5. https://doi.org/10.1097/TA.0b013e3182ab1b4d. This study reports that screening based on risk factors alone may miss a substantial number of patients with BCVI and suggests that more liberalized screening is warranted.

    Article  PubMed  Google Scholar 

  35. Kerwin AJ, Bynoe RP, Murray J, Hudson ER, Close TP, Gifford RR, et al. Liberalized screening for blunt carotid and vertebral artery injuries is justified. J Trauma. 2001;51(2):308–14.

    Article  CAS  Google Scholar 

  36. •• Brinjikji W, Demchuk AM, Murad MH, Rabinstein AA, McDonald RJ, McDonald JS, et al. Neurons over nephrons: systematic review and meta-analysis of contrast-induced nephropathy in patients with acute stroke. Stroke. 2017;48(7):1862–8. https://doi.org/10.1161/STROKEAHA.117.016771. This study demonstrates the very low risk of contrast nephropathy when considering imaging studies for patients with acute stroke.

    Article  PubMed  Google Scholar 

  37. Biffl WL, Moore EE. Computed tomographic angiography for blunt cerebrovascular injuries: don’t throw out the baby with the bathwater. Ann Surg. 2011;253(3):451–2. https://doi.org/10.1097/SLA.0b013e31820d990a.

    Article  PubMed  Google Scholar 

  38. Utter GH, Hollingworth W, Hallam DK, Jarvik JG, Jurkovich GJ. Sixteen-slice CT angiography in patients with suspected blunt carotid and vertebral artery injuries. J Am Coll Surg. 2006;203(6):838–48. https://doi.org/10.1016/j.jamcollsurg.2006.08.003.

    Article  PubMed  Google Scholar 

  39. Schneidereit NP, Simons R, Nicolaou S, Graeb D, Brown DR, Kirkpatrick A, et al. Utility of screening for blunt vascular neck injuries with computed tomographic angiography. J Trauma. 2006;60(1):209–15; discussion 15-6. https://doi.org/10.1097/01.ta.0000195651.60080.2c.

    Article  PubMed  Google Scholar 

  40. Eastman AL, Chason DP, Perez CL, McAnulty AL, Minei JP. Computed tomographic angiography for the diagnosis of blunt cervical vascular injury: is it ready for primetime? J Trauma. 2006;60(5):925–9; discussion 9. https://doi.org/10.1097/01.ta.0000197479.28714.62.

    Article  PubMed  Google Scholar 

  41. Shahan CP, Magnotti LJ, Stickley SM, Weinberg JA, Hendrick LE, Uhlmann RA, et al. A safe and effective management strategy for blunt cerebrovascular injury: avoiding unnecessary anticoagulation and eliminating stroke. J Trauma Acute Care Surg. 2016;80(6):915–22. https://doi.org/10.1097/TA.0000000000001041.

    Article  PubMed  Google Scholar 

  42. Nace SR, Gentry LR. Cerebrovascular trauma. Neuroimaging Clin N Am. 2014;24(3):487–511, viii. https://doi.org/10.1016/j.nic.2014.03.006.

    Article  PubMed  Google Scholar 

  43. Liang T, Tso DK, Chiu RY, Nicolaou S. Imaging of blunt vascular neck injuries: a review of screening and imaging modalities. AJR Am J Roentgenol. 2013;201(4):884–92. https://doi.org/10.2214/AJR.12.9664.

    Article  PubMed  Google Scholar 

  44. • Crawford JD, Allan KM, Patel KU, Hart KD, Schreiber MA, Azarbal AF, et al. The natural history of indeterminate blunt cerebrovascular injury. JAMA Surg. 2015;150(9):841–7. https://doi.org/10.1001/jamasurg.2015.1692. This study reports the risk of stroke with indeterminant BCVI on initial imaging.

    Article  PubMed  Google Scholar 

  45. Sakurai K, Miura T, Sagisaka T, Hattori M, Matsukawa N, Mase M, et al. Evaluation of luminal and vessel wall abnormalities in subacute and other stages of intracranial vertebrobasilar artery dissections using the volume isotropic turbo-spin-echo acquisition (VISTA) sequence: a preliminary study. J Neuroradiol. 2013;40(1):19–28. https://doi.org/10.1016/j.neurad.2012.02.005.

    Article  PubMed  Google Scholar 

  46. Hunter MA, Santosh C, Teasdale E, Forbes KP. High-resolution double inversion recovery black-blood imaging of cervical artery dissection using 3T MR imaging. AJNR Am J Neuroradiol. 2012;33(11):E133–7. https://doi.org/10.3174/ajnr.A2599.

    Article  CAS  PubMed  Google Scholar 

  47. Luo Y, Guo ZN, Niu PP, Liu Y, Zhou HW, Jin H, et al. 3D T1-weighted black blood sequence at 3.0 Tesla for the diagnosis of cervical artery dissection. Stroke Vasc Neurol. 2016;1(3):140–6. https://doi.org/10.1136/svn-2016-000028.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Brunser AM, Lavados PM, Hoppe A, Muñoz-Venturelli P, Sujima E, López J, et al. Transcranial Doppler as a predictor of ischemic events in carotid artery dissection. J Neuroimaging. 2017;27(2):232–6. https://doi.org/10.1111/jon.12379.

    Article  PubMed  Google Scholar 

  49. Achtereekte HA, van der Kruijk RA, Hekster RE, Keunen RW. Diagnosis of traumatic carotid artery dissection by transcranial Doppler ultrasound: case report and review of the literature. Surg Neurol. 1994;42(3):240–4.

    Article  CAS  Google Scholar 

  50. Morton RP, Hanak BW, Levitt MR, Fink KR, Peterson EC, Vilela MD, et al. Blunt traumatic occlusion of the internal carotid and vertebral arteries. J Neurosurg. 2014;120(6):1446–50. https://doi.org/10.3171/2014.2.JNS131658.

    Article  PubMed  Google Scholar 

  51. Bonow RH, Witt CE, Mosher BP, Mossa-Basha M, Vavilala MS, Rivara FP, et al. Transcranial Doppler microemboli monitoring for stroke risk stratification in blunt cerebrovascular injury. Crit Care Med. 2017;45(10):e1011–e7. https://doi.org/10.1097/CCM.0000000000002549.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Purvis D, Aldaghlas T, Trickey AW, Rizzo A, Sikdar S. A novel decision tree approach based on transcranial Doppler sonography to screen for blunt cervical vascular injuries. J Ultrasound Med. 2013;32(6):1023–31. https://doi.org/10.7863/ultra.32.6.1023.

    Article  PubMed  Google Scholar 

  53. DiCocco JM, Fabian TC, Emmett KP, Magnotti LJ, Zarzaur BL, Khan N, et al. Functional outcomes following blunt cerebrovascular injury. J Trauma Acute Care Surg. 2013;74(4):955–60. https://doi.org/10.1097/TA.0b013e318287800f.

    Article  PubMed  Google Scholar 

  54. Miller PR, Fabian TC, Croce MA, Cagiannos C, Williams JS, Vang M, et al. Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg. 2002;236(3):386–93; discussion 93-5. https://doi.org/10.1097/01.SLA.0000027174.01008.A0.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Seth R, Obuchowski AM, Zoarski GH. Endovascular repair of traumatic cervical internal carotid artery injuries: a safe and effective treatment option. AJNR Am J Neuroradiol. 2013;34(6):1219–26. https://doi.org/10.3174/ajnr.A3337.

    Article  CAS  PubMed  Google Scholar 

  56. Griessenauer CJ, Fleming JB, Richards BF, Cava LP, Curé JK, Younan DS, et al. Timing and mechanism of ischemic stroke due to extracranial blunt traumatic cerebrovascular injury. J Neurosurg. 2013;118(2):397–404. https://doi.org/10.3171/2012.11.JNS121038.

    Article  PubMed  Google Scholar 

  57. Callcut RA, Hanseman DJ, Solan PD, Kadon KS, Ingalls NK, Fortuna GR, et al. Early treatment of blunt cerebrovascular injury with concomitant hemorrhagic neurologic injury is safe and effective. J Trauma Acute Care Surg. 2012;72(2):338–45; discussion 45-6. https://doi.org/10.1097/TA.0b013e318243d978.

    Article  PubMed  Google Scholar 

  58. McNutt MK, Kale AC, Kitagawa RS, Turkmani AH, Fields DW, Baraniuk S, et al. Management of blunt cerebrovascular injury (BCVI) in the multisystem injury patient with contraindications to immediate anti-thrombotic therapy. Injury. 2018;49(1):67–74. https://doi.org/10.1016/j.injury.2017.07.036.

    Article  PubMed  Google Scholar 

  59. Shahan CP, Magnotti LJ, McBeth PB, Weinberg JA, Croce MA, Fabian TC. Early antithrombotic therapy is safe and effective in patients with blunt cerebrovascular injury and solid organ injury or traumatic brain injury. J Trauma Acute Care Surg. 2016;81(1):173–7. https://doi.org/10.1097/TA.0000000000001058.

    Article  CAS  PubMed  Google Scholar 

  60. Wahl WL, Brandt MM, Thompson BG, Taheri PA, Greenfield LJ. Antiplatelet therapy: an alternative to heparin for blunt carotid injury. J Trauma. 2002;52(5):896–901.

    CAS  PubMed  Google Scholar 

  61. Colella JJ, Diamond DL. Blunt carotid injury: reassessing the role of anticoagulation. Am Surg. 1996;62(3):212–7.

    CAS  PubMed  Google Scholar 

  62. Eachempati SR, Vaslef SN, Sebastian MW, Reed RL. Blunt vascular injuries of the head and neck: is heparinization necessary? J Trauma. 1998;45(6):997–1004.

    Article  CAS  Google Scholar 

  63. Kennedy F, Lanfranconi S, Hicks C, Reid J, Gompertz P, Price C, et al. Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology. 2012;79(7):686–9. https://doi.org/10.1212/WNL.0b013e318264e36b.

    Article  CAS  PubMed  Google Scholar 

  64. Markus HS, Hayter E, Levi C, Feldman A, Venables G, Norris J, et al. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol. 2015;14(4):361–7. https://doi.org/10.1016/S1474-4422(15)70018-9.

    Article  CAS  PubMed  Google Scholar 

  65. Daou B, Hammer C, Mouchtouris N, Starke RM, Koduri S, Yang S, et al. Anticoagulation vs antiplatelet treatment in patients with carotid and vertebral artery dissection: a study of 370 patients and literature review. Neurosurgery. 2017;80(3):368–79. https://doi.org/10.1093/neuros/nyw086.

    Article  PubMed  Google Scholar 

  66. Tso MK, Lee MM, Ball CG, Morrish WF, Mitha AP, Kirkpatrick AW, et al. Clinical utility of a screening protocol for blunt cerebrovascular injury using computed tomography angiography. J Neurosurg. 2017;126(4):1033–41. https://doi.org/10.3171/2016.1.JNS151545.

    Article  PubMed  Google Scholar 

  67. Moon K, Albuquerque FC, Cole T, Gross BA, McDougall CG. Stroke prevention by endovascular treatment of carotid and vertebral artery dissections. J Neurointerv Surg. 2017;9(10):952–7. https://doi.org/10.1136/neurintsurg-2016-012565.

    Article  PubMed  Google Scholar 

  68. Marnat G, Mourand I, Eker O, Machi P, Arquizan C, Riquelme C, et al. Endovascular management of tandem occlusion stroke related to internal carotid artery dissection using a distal to proximal approach: insight from the RECOST study. AJNR Am J Neuroradiol. 2016;37(7):1281–8. https://doi.org/10.3174/ajnr.A4752.

    Article  CAS  PubMed  Google Scholar 

  69. Sivan-Hoffmann R, Gory B, Armoiry X, Goyal M, Riva R, Labeyrie PE, et al. Stent-retriever thrombectomy for acute anterior ischemic stroke with tandem occlusion: a systematic review and meta-analysis. Eur Radiol. 2017;27(1):247–54. https://doi.org/10.1007/s00330-016-4338-y.

    Article  PubMed  Google Scholar 

  70. Shahan CP, Sharpe JP, Stickley SM, Manley NR, Filiberto DM, Fabian TC, et al. The changing role of endovascular stenting for blunt cerebrovascular injuries. J Trauma Acute Care Surg. 2018;84(2):308–11. https://doi.org/10.1097/TA.0000000000001740.

    Article  PubMed  Google Scholar 

  71. • Burlew CC, Biffl WL, Moore EE, Pieracci FM, Beauchamp KM, Stovall R, et al. Endovascular stenting is rarely necessary for the management of blunt cerebrovascular injuries. J Am Coll Surg. 2014;218(5):1012–7. https://doi.org/10.1016/j.jamcollsurg.2014.01.042. This study demonstrated that most dissections heal without the need for endovascular stenting.

    Article  PubMed  Google Scholar 

  72. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–e110. https://doi.org/10.1161/STR.0000000000000158.

    Article  PubMed  Google Scholar 

  73. Foreman PM, Griessenauer CJ, Falola M, Harrigan MR. Extracranial traumatic aneurysms due to blunt cerebrovascular injury. J Neurosurg. 2014;120(6):1437–45. https://doi.org/10.3171/2014.3.JNS131959.

    Article  PubMed  Google Scholar 

  74. Teehan EP, Padberg FT, Thompson PN, Lee BC, Silva M, Jamil Z, et al. Carotid arterial trauma: assessment with the Glasgow Coma Scale (GCS) as a guide to surgical management. Cardiovasc Surg. 1997;5(2):196–200.

    Article  CAS  Google Scholar 

  75. Unger SW, Tucker WS, Mrdeza MA, Wellons HA, Chandler JG. Carotid arterial trauma. Surgery. 1980;87(5):477–87.

    CAS  PubMed  Google Scholar 

  76. Jensen J, Salottolo K, Frei D, Loy D, McCarthy K, Wagner J, et al. Comprehensive analysis of intra-arterial treatment for acute ischemic stroke due to cervical artery dissection. J Neurointerv Surg. 2017;9(7):654–8. https://doi.org/10.1136/neurintsurg-2016-012421.

    Article  PubMed  Google Scholar 

  77. Zinkstok SM, Vergouwen MD, Engelter ST, Lyrer PA, Bonati LH, Arnold M, et al. Safety and functional outcome of thrombolysis in dissection-related ischemic stroke: a meta-analysis of individual patient data. Stroke. 2011;42(9):2515–20. https://doi.org/10.1161/STROKEAHA.111.617282.

    Article  PubMed  Google Scholar 

  78. Campbell BCV, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, et al. Tenecteplase versus alteplase before thrombectomy for ischemic stroke. N Engl J Med. 2018;378(17):1573–82. https://doi.org/10.1056/NEJMoa1716405.

    Article  CAS  PubMed  Google Scholar 

  79. Hoving JW, Marquering HA, Majoie CBLM. Endovascular treatment in patients with carotid artery dissection and intracranial occlusion: a systematic review. Neuroradiology. 2017;59(7):641–7. https://doi.org/10.1007/s00234-017-1850-y.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Fields JD, Lutsep HL, Rymer MR, Budzik RF, Devlin TG, Baxter BW, et al. Endovascular mechanical thrombectomy for the treatment of acute ischemic stroke due to arterial dissection. Interv Neuroradiol. 2012;18(1):74–9. https://doi.org/10.1177/159101991201800110.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708–18. https://doi.org/10.1056/NEJMoa1713973.

    Article  PubMed  Google Scholar 

  82. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11–21. https://doi.org/10.1056/NEJMoa1706442.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Dr. Howard S. Kirshner for the topic title and initial topic review.

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Authors and Affiliations

  1. Department of Neurology, University of Florida, 1149 Newell Dr., PO Box 100236, Gainesville, FL, 32610, USA

    David K. Stone, Vyas T. Viswanathan & Christina A. Wilson

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  2. Vyas T. Viswanathan
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  3. Christina A. Wilson
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Correspondence to Christina A. Wilson.

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Christina A. Wilson reports personal fees from UpToDate, personal fees from Medlink Neurology, outside the submitted work. David K. Stone and Vyas T. Viswanathan each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Stroke

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Stone, D.K., Viswanathan, V.T. & Wilson, C.A. Management of Blunt Cerebrovascular Injury. Curr Neurol Neurosci Rep 18, 98 (2018). https://doi.org/10.1007/s11910-018-0906-7

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  • DOI: https://doi.org/10.1007/s11910-018-0906-7

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