Angiographic detection of carotid and vertebral arterial injury in the high-energy blunt trauma patient

Background and Objective: Injury to the carotid and vertebral arteries is an identified risk to patients after blunt high-energy cranio-cervical trauma with an associated risk of thromboembolic stroke. We sought to determine the incidence, features, and risk factors of arterial injury using selective cerebral angiography in a high-risk trauma patient subset. Methods: Blunt trauma patients with a high-energy mechanism were selected to undergo screening cerebral angiography if they met one of the following criteria: (1) cervical spine hyperextension/hyperflexion injury, (2) skull-base or facial fracture, (3) lateralizing neurologic deficit, ischemic deficit, or cerebral infarction, or (4) hemorrhage of arterial origin. Results: Of 69 screened patients 20 were found to have a vascular injury (28.9%), including 13 carotid and 15 vertebral; 9 of the 20 patients with vascular injury were symptomatic (45%). The most frequent injuries were intimal dissections (8/28), pseudoaneurysms (6/28), and vessel occlusions (5/28); 8 lesions were intracranial and 20 cervical. Displaced facial fractures (P < 0.02) but not skull-base fracture were predictive of carotid injury; multilevel cervical spine fractures (P < 0.001) and transverse foraminal fractures (P < 0.02) were associated with vertebral injury. Conclusions: Cerebral angiography in a selected group of trauma patients was found to yield a significant rate of carotid and vertebral arterial injury, a finding that had implications to subsequent clinical management.