The devastating potential of blunt vertebral arterial injuries.

Blunt vertebral arterial injury (BVI) has historically been considered an uncommon event of relative insignificance. There have been many case reports describing BVI-associated cerebrovascular accidents, both ischemic and hemorrhagic, but clinical series of vertebral artery injuries have been composed primarily of penetrating injuries. In the seven largest reports, only 8 (4%) of 195 total reported patients had sustained blunt mechanisms; these 8 patients as a group had reasonably good outcomes, leading to the belief that BVI is relatively innocuous. 1–7 This concept was further supported in small series dealing specifically with blunt injuries. 8–14 In 1996 we adopted an aggressive screening protocol for blunt carotid arterial injuries. 15 Using four-vessel cerebral arteriography, we began identifying a significant number of BVIs in addition to blunt carotid injury. Fabian et al 16 previously demonstrated the benefits of systemic heparin therapy in treating patients with blunt carotid injury; our experience with asymptomatic patients affirmed the Memphis data. 15 Extrapolation of blunt carotid injury treatment principles to BVI, however, has not been supported. Collectively, the consensus in the literature to date is that asymptomatic patients with narrowing, irregularity, or occlusion of the vertebral artery do not require treatment. 1–7,11,12 The purpose of this study was to analyze our experience and formulate a rational diagnostic and therapeutic approach to BVI.