Blunt Cerebrovascular Injury (BCVI)

Screening and graded treatment for blunt carotid/vertebral artery injuries.

AHS Official

Updated: 02/05/2025

BCVICTA neckDenver criteriaASA

On this page3 sections

🔍Indications for CTA Neck

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Signs/Symptoms:

Arterial hemorrhage from head, mouth, nose, or ears
Large or expanding cervical hematoma · cervical bruit
Focal/lateralizing neurologic deficit, TIA, Horner syndrome, or cerebral infarction on CT/MRI
Unexplained GCS or neurologic exam inconsistent with head CT

Risk Factors:

Severe cervical hyperextension/rotation or hyperflexion mechanism
LeFort II/III fractures · basilar skull fracture near carotid canal · occipital condyle fracture
Severe TBI with GCS <6 · C-spine fracture, subluxation, or ligamentous injury
Near hanging with cerebral anoxia · clothesline/seatbelt sign with pain, swelling, or AMS
TBI with thoracic injury · scalp degloving · thoracic vascular injury · upper/first rib fractures

💊Treatment by Grade

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Grade	Treatment
I–II	Start ASA unless contraindicated by Neurosurgery. Repeat CTA in 7 days or before discharge. If confirmed, continue ASA for 3 months and arrange PCP/vascular follow-up.
Progression on repeat imaging	Consult inpatient vascular surgery.
III–IV	Consult inpatient vascular surgery.
V	Most often operative; defer to trauma attending.

📊BCVI Grading

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Grade I: intimal irregularity or dissection with <25% luminal narrowing
Grade II: dissection/intramural hematoma with ≥25% narrowing, intraluminal clot, or visible intimal flap
Grade III: pseudoaneurysm or hemodynamically insignificant AV fistula
Grade IV: complete occlusion
Grade V: transection with active extravasation or significant AV fistula; often lethal