{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T19:39:39Z","timestamp":1769197179541,"version":"3.49.0"},"reference-count":27,"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":"<jats:sec>\n<jats:title>OBJECT<\/jats:title>\n<jats:p>Proper screening, management, and follow-up of Grade 1 and 2 blunt carotid artery injuries (BCIs) remains controversial. These low-grade BCIs 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<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective review of a prospectively maintained database of all blunt traumatic carotid and vertebral artery injuries treated between August 2003 and April 2013 was performed and Grade 1 and 2 BCIs were identified. Grade 1 injuries are defined as a vessel lumen stenosis of less than 25%, and Grade 2 injuries are defined as a stenosis of the vessel lumen between 25% and 50%. Demographic information, radiographic imaging, 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<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>One hundred seventeen Grade 1 and 2 BCIs in 100 patients were identified and available for follow-up. The mean follow-up duration was 60 days. Final imaging of Grade 1 and 2 BCIs demonstrated that 64% of cases had resolved, 13% of cases were radiographically stable, and 9% were improved, whereas 14% radiographically worsened. Of the treatments received, 54% of cases were treated with acetylsalicylic acid (ASA), 31% received no treatment, and 15% received various medications and treatments, including endovascular stenting. There was 1 cerebral infarction that was thought to be related to bilateral Grade 2 BCI, which developed soon after hospital admission.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The majority of Grade 1 and 2 BCIs remained stable or improved at final follow-up. Despite a 14% rate of radiographic worsening in the Grade 1 and 2 BCIs cohort, there were no adverse clinical outcomes associated with these radiographic changes. The stroke rate was 1% in this low-grade BCIs cohort, which may be an overestimate. The use of ASA or other antiplatelet or anticoagulant medications in these low-grade BCIs did not appear to correlate with radiographic injury stability, nor with a decreased rate of cerebral infarction. Although these data suggest that these Grade 1 and 2 BCIs 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\/2015.1.jns14642","type":"journal-article","created":{"date-parts":[[2015,3,20]],"date-time":"2015-03-20T14:44:38Z","timestamp":1426862678000},"page":"1196-1201","source":"Crossref","is-referenced-by-count":46,"title":["Clinical and radiographic outcomes following traumatic Grade 1 and 2 carotid 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":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Sharp","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen A.","family":"Figueroa","sequence":"additional","affiliation":[{"name":"Neurocritical Care, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander L.","family":"Eastman","sequence":"additional","affiliation":[{"name":"Trauma Surgery, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles V.","family":"Hatchette","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher J.","family":"Madden","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kim L.","family":"Rickert","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns14642","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1594","DOI":"10.1016\/S0140-6736(99)07083-X","article-title":"Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study","volume":"354","author":"Bendszus","year":"1999"},{"key":"b2-jns14642","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":"b3-jns14642","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-jns14642","series-title":"World J Surg","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1007\/s00268-001-0056-x","article-title":"Blunt carotid and vertebral arterial injuries","volume":"25","author":"Biffl","year":"2001"},{"key":"b5-jns14642","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":"b6-jns14642","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"850","DOI":"10.1097\/00005373-200211000-00008","article-title":"Noninvasive diagnosis of blunt cerebrovascular injuries: a preliminary report","volume":"53","author":"Biffl","year":"2002"},{"key":"b7-jns14642","series-title":"Ann Vasc Surg","first-page":"e11","article-title":"Endovascular treatment of bilateral carotid artery pseudoaneurysms after blunt carotid injury","volume":"28","author":"Cafasso","year":"2014"},{"key":"b8-jns14642","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":"b9-jns14642","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1097\/01.ta.0000197479.28714.62","article-title":"Computed tomographic angiography for the diagnosis of blunt cervical vascular injury: is it ready for primetime?","volume":"60","author":"Eastman","year":"2006"},{"key":"b10-jns14642","series-title":"J Trauma","first-page":"551","article-title":"CTA-based screening reduces time to diagnosis and stroke rate in blunt cervical vascular injury","volume":"67","author":"Eastman","year":"2009"},{"key":"b11-jns14642","series-title":"J Am Coll Surg","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1016\/j.jamcollsurg.2006.12.041","article-title":"Antithrombotic therapy and endovascular stents are effective treatment for blunt carotid injuries: results from longterm followup","volume":"204","author":"Edwards","year":"2007"},{"key":"b12-jns14642","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","volume":"118","author":"Griessenauer","year":"2013"},{"key":"b13-jns14642","series-title":"J Neurointerv Surg","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1136\/neurintsurg-2012-010605","article-title":"Current trends in endovascular management of traumatic cerebrovascular injury","volume":"6","author":"Kansagra","year":"2014"},{"key":"b14-jns14642","series-title":"J Vasc Surg","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1016\/j.jvs.2009.10.108","article-title":"Comparison of conservative and operative treatment for blunt carotid injuries: analysis of the National Trauma Data Bank","volume":"51","author":"Li","year":"2010"},{"key":"b15-jns14642","series-title":"Semin Roentgenol","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1053\/j.ro.2012.05.001","article-title":"Imaging of blunt cerebrovascular injuries","volume":"47","author":"Liang","year":"2012"},{"key":"b16-jns14642","series-title":"Arch Surg","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1001\/archsurg.139.6.609","article-title":"Blunt carotid artery injury: the futility of aggressive screening and diagnosis","volume":"139","author":"Mayberry","year":"2004"},{"key":"b17-jns14642","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1097\/00005373-200108000-00009","article-title":"Blunt cerebrovascular injuries: diagnosis and treatment","volume":"51","author":"Miller","year":"2001"},{"key":"b18-jns14642","series-title":"Ann Surg","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1097\/00000658-200209000-00015","article-title":"Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes","volume":"236","author":"Miller","year":"2002"},{"key":"b19-jns14642","series-title":"Eur J Vasc Endovasc Surg","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1016\/j.ejvs.2010.05.003","article-title":"An update of the role of endovascular repair in blunt carotid artery trauma","volume":"40","author":"Moulakakis","year":"2010"},{"key":"b20-jns14642","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"884","DOI":"10.1148\/radiol.2373042189","article-title":"Blunt cerebrovascular injury in patients with blunt multiple trauma: diagnostic accuracy of duplex Doppler US and early CT angiography","volume":"237","author":"Mutze","year":"2005"},{"key":"b21-jns14642","series-title":"J Comput Assist Tomogr","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1097\/00004728-199603000-00004","article-title":"Spontaneous vertebral dissection: clinical, conventional angiographic, CT, and MR findings","volume":"20","author":"Provenzale","year":"1996"},{"key":"b22-jns14642","series-title":"Ann Surg","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1097\/SLA.0b013e318288c514","article-title":"Diagnostic accuracy of computed tomographic angiography for blunt cerebrovascular injury detection in trauma patients: a systematic review and meta-analysis","volume":"257","author":"Roberts","year":"2013"},{"key":"b23-jns14642","series-title":"Br Med J","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1136\/bmj.1.5801.685-a","article-title":"Yoga and vertebral arteries","volume":"1","author":"Russell","year":"1972"},{"key":"b24-jns14642","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1056\/NEJM200103223441206","article-title":"Spontaneous dissection of the carotid and vertebral arteries","volume":"344","author":"Schievink","year":"2001"},{"key":"b25-jns14642","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"450","DOI":"10.3171\/2014.4.JNS132235","article-title":"Clinical and radiological outcomes following traumatic Grade 1 and 2 vertebral artery injuries: a 10-year retrospective analysis from a Level 1 trauma center","volume":"121","author":"Scott","year":"2014"},{"key":"b26-jns14642","series-title":"J Trauma","first-page":"896","article-title":"Antiplatelet therapy: an alternative to heparin for blunt carotid injury","volume":"52","author":"Wahl","year":"2002"},{"key":"b27-jns14642","series-title":"J Trauma Acute Care Surg","doi-asserted-by":"publisher","first-page":"1601","DOI":"10.1097\/TA.0b013e318246ead4","article-title":"Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury","volume":"72","author":"Wang","year":"2012"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/122\/5\/article-p1196.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/122\/5\/article-p1196.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/122\/5\/article-p1196.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T00:00:43Z","timestamp":1658707243000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/122\/5\/article-p1196.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,5]]},"references-count":27,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2015.1.jns14642","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,5]]}}}