{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:13:59Z","timestamp":1783775639188,"version":"3.55.0"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2015,5]]},"abstract":"\nOBJECT<\/jats:title>\nGrade 3 and 4 blunt vertebral artery (VA) injuries may carry a different natural course from that of lower-grade blunt VA injuries. Proper screening, management, and follow-up of these injuries remain controversial. Grade 3 and 4 blunt VA injuries were analyzed to define their natural history and establish a rational management plan based on lesion progression and cerebral infarction.<\/jats:p><\/jats:sec>\n\nMETHODS<\/jats:title>\nA retrospective review of a prospectively maintained database of all blunt traumatic carotid and vertebral artery injuries from August 2003 to April 2013 was performed, and Grade 3 and 4 blunt VA injuries were identified. Grade 3 injuries were defined as stenosis of the vessel greater than 50% or the development of a pseudoaneurysm, and Grade 4 injuries were defined as complete vessel occlusion. Demographic information, radiographic imaging findings, number of imaging sessions performed per individual, length of radiographic follow-up, radiographic outcome at end of follow-up, treatment(s) provided, and documentation of ischemic stroke or transient ischemic attack were recorded.<\/jats:p><\/jats:sec>\n\nRESULTS<\/jats:title>\nA total of 79 high-grade (Grade 3 and 4) blunt VA injuries in 67 patients were identified. Fifty-nine patients with 66 high-grade blunt VA injuries were available for follow-up. There were 17 patients with 23 Grade 3 injuries and 42 patients with 43 Grade 4 injuries. The mean follow-up duration was 58 days for Grade 3 and 67 days for Grade 4 blunt VA injuries. Repeat imaging of Grade 3 blunt VA injuries showed that 39% of injuries were radiographically stable, 43% resolved, and 13% improved, while 1 injury radiographically worsened. Repeat imaging of the Grade 4 blunt VA injuries showed that 65% of injuries were radiographically stable (persistent occlusion), 30% improved (recanalization of the vessel), and in 2 cases (5%) the injury resolved. All Grade 3 injuries that were treated were managed with aspirin or clopidogrel alone, as were the majority of Grade 4 injuries. There were 3 cerebral infarctions thought to be related to Grade 4 blunt VA injuries, which were likely present on admission. All 3 of these patients died at a mean of 13.7 days after hospital admission. No cerebral infarctions directly related to Grade 3 blunt VA injuries were identified.<\/jats:p><\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nThe majority of high-grade blunt VA injuries remain stable or are improved at final follow-up. Despite a 4% rate of radiographic worsening in the Grade 3 blunt VA injury group and a 35% recanalization rate in the Grade 4 blunt VA injury group, there were no adverse clinical outcomes associated with these radiographic changes. No cerebral infarctions were noted in the Grade 3 group. A 7% stroke rate was identified in the Grade 4 blunt VA injury group; however, this was confined to the immediate postinjury period and was associated with 100% mortality. While these data suggest that these high-grade vertebral artery injuries may require less intensive radiographic follow-up, future prospective studies are needed to make conclusive changes related to treatment and management.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.9.jns1461","type":"journal-article","created":{"date-parts":[[2014,10,24]],"date-time":"2014-10-24T14:12:05Z","timestamp":1414159925000},"page":"1202-1207","source":"Crossref","is-referenced-by-count":31,"title":["Clinical and radiological outcomes following traumatic Grade 3 and 4 vertebral artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey"],"prefix":"10.3171","volume":"122","author":[{"given":"William W.","family":"Scott","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Sharp","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen A.","family":"Figueroa","sequence":"additional","affiliation":[{"name":"Neurocritical Care and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander L.","family":"Eastman","sequence":"additional","affiliation":[{"name":"Trauma Surgery, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles V.","family":"Hatchette","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Madden","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim L.","family":"Rickert","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns1461","series-title":"J Trauma","first-page":"1150","article-title":"Western Trauma Association critical decisions in trauma: screening for and treatment of blunt cerebrovascular injuries","volume":"67","author":"Biffl","year":"2009"},{"key":"b2-jns1461","series-title":"Ann Surg","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1097\/00000658-200005000-00007","article-title":"The devastating potential of blunt vertebral arterial injuries","volume":"231","author":"Biffl","year":"2000"},{"key":"b3-jns1461","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1097\/00005373-199911000-00004","article-title":"Blunt carotid arterial injuries: implications of a new grading scale","volume":"47","author":"Biffl","year":"1999"},{"key":"b4-jns1461","series-title":"Ann Surg","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1097\/00000658-200205000-00012","article-title":"Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography","volume":"235","author":"Biffl","year":"2002"},{"key":"b5-jns1461","series-title":"Arch Surg","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1001\/archsurg.2009.111","article-title":"Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents","volume":"144","author":"Cothren","year":"2009"},{"key":"b6-jns1461","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"397","DOI":"10.3171\/2012.11.JNS121038","article-title":"Timing and mechanism of ischemic stroke due to extracranial blunt traumatic cerebrovascular injury. 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