Blunt cerebrovascular injury (BCVI)

North of Scotland major trauma guidelines
NHS Grampian

BCVIs (Blunt Cerebrovascular Injury) will not be visualised on plain CT scans unless contrast is specifically requested. Up to 20% will be missed, with stroke being the most devastating consequence.

Extended Denver criteria

See extended Denver criteria for blunt cervical vascular injury.

Grades of injury

  • Grade I (intimal injury <25% narrowing)
  • Grade II (dissection or intramural haematoma >25%)
  • Grade III (pseudoaneurysm)
  • Grade IV (occlusion)
  • Grade V (transection with extravasation).

Management

  • Surgery is indicated for Grade II, III, IV & V injuries that are surgically accessible
  • Endovascular treatment for Grade V injuries that are not surgically accessible
  • Treat Grade I injuries and Grade II, III, IV and V injuries not undergoing surgical intervention with Aspirin (or heparin) and repeat CTA in 7-10 days
  • If Repeat CTA shows a healed injury stop treatment otherwise continue treatment for 3-6 months and re-image.