Abstract 1122‐000114: Blunt Traumatic Vertebral Artery Injury: Incidence, Treatment, and Outcomes

Introduction : Blunt cerebrovascular injury (BCVI) refers to any injury to the carotid or vertebral arteries sustained via blunt trauma. Computed tomographic angiography (CTA) has become a standard and widely available screening tool for BCVI, often allowing injuries to be detected on admission. Prior research has shown that BCVI is associated with subsequent stroke. Treatment protocols vary by institution, and the optimal treatment method for these injuries is not standardized. Methods : This research was approved by the IRB. All patients presenting to a level 1 trauma center from 2011 to 2018 were screened for inclusion using the Primordial Database imaging report search tool (San Mateo, CA). All included patients underwent CTA within 24 hours of presentation. Patients were excluded if they had penetrating injury, age <16 years, or concomitant carotid injury. Data was retrospectively collected. Injuries were graded according to the criteria of Biffl et al. Treatment and follow up imaging of BCVI was determined by the vascular neurosurgeon on call. Results : A total of 2819 patients underwent screening CTA, with 156 patients (5.5%) identified with isolated vertebral artery injuries. Sixteen patients (10%) had bilateral vertebral artery injuries, for a total of 172 injured vertebral arteries. There was a male predominance (n = 97, 62%). Ninety‐two patients (59%) had a cervical spine fracture at the level of injury. Three posterior circulation strokes were detected, all within 24 hours of admission, prior to starting any treatment. Treatment regimens included aspirin (n = 135 vessels), clopidigrel (n = 1), anticoagulation (n = 2), or no treatment (n = 18). Follow up imaging was available for 84 patients (98 arteries). Three patients had worsening Biffl grade on follow‐up CTA, and the remainder were stable or improved. The three worsened injuries were all grade 2 on initial presentation. Conclusions : In our patient population, isolated blunt vertebral artery injuries were treated with multiple regimens. The majority of patients in our group were treated with aspirin; no strokes were detected after the initiation of therapy, regardless of the treatment modality or the fate of the injured. Our study is not randomized and the treatment groups are not evenly distributed. Further investigation is required to address the optimal method and duration of treatment for blunt vertebral artery injury. However, our data suggest that aspirin alone may be sufficient therapy for isolated vertebral artery injuries.