{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:56:55Z","timestamp":1790139415234,"version":"4.0.1"},"reference-count":105,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T00:00:00Z","timestamp":1746144000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Vertebral artery injury (VAI) is a known complication of blunt cervical spine trauma with a potential risk of stroke. Factors including cervical bony injury, spinal cord injury, and overall trauma severity have been linked to an increased risk of VAI. Despite its prevalence, there is little consensus on various aspects of this pathology, including its initial screening, diagnostic approaches, and therapeutic strategies. A recent systematic review and meta-analysis from our group highlighted the dynamic nature of vertebral artery occlusion, revealing the underrecognized recanalization rates and potential stroke risks associated with delayed recanalization. While anticoagulant and\/or antiplatelet therapy (ACAP) remains the cornerstone of VAI management, treatment is often complicated by co-existing injuries, such as intracranial hemorrhage or cervical trauma, which may preclude or delay ACAP usage or necessitate surgical intervention. This comprehensive narrative review synthesizes the latest evidence on VAI and associated ischemic sequelae, with the goal of elucidating its pathophysiology and natural history, summarizing current data on screening and diagnosis, and exploring key considerations for medical and endovascular management.<\/jats:p>","DOI":"10.3390\/jcm14093159","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T08:28:11Z","timestamp":1746174491000},"page":"3159","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Traumatic Vertebral Artery Injury: Diagnosis, Natural History, and Key Considerations for Management"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9904-3518","authenticated-orcid":false,"given":"Ben","family":"Teasdale","sequence":"first","affiliation":[{"name":"Department of Neurology, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin","family":"Owolo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9538-7708","authenticated-orcid":false,"given":"Varun","family":"Padmanaban","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aladine A.","family":"Elsamadicy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale-New Haven Hospital, Yale University, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3357-4134","authenticated-orcid":false,"given":"Abdelaziz","family":"Amllay","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale-New Haven Hospital, Yale University, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesh M.","family":"Shankar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale-New Haven Hospital, Yale University, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5351-5628","authenticated-orcid":false,"given":"Penina P.","family":"Krieger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2958-3484","authenticated-orcid":false,"given":"Robert W.","family":"Regenhardt","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Texas Health Science Center, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan M.","family":"Hebert","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale-New Haven Hospital, Yale University, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Stapleton","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D.","family":"Rabinov","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA"},{"name":"Department of Radiology, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles C.","family":"Matouk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale-New Haven Hospital, Yale University, New Haven, CT 06510, USA"},{"name":"Department of Radiology, Yale-New Haven Hospital, Yale University, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman B.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5857-5718","authenticated-orcid":false,"given":"Nanthiya","family":"Sujijantarat","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","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","journal-title":"J. Trauma"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"665","DOI":"10.3171\/2015.1.SPINE141174","article-title":"Corrective spinal surgery may be protective against stroke in patients with blunt traumatic vertebral artery occlusion","volume":"23","author":"Foreman","year":"2015","journal-title":"J. Neurosurg. Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1161\/STROKEAHA.119.026810","article-title":"Ischemic stroke due to blunt traumatic cerebrovascular injury","volume":"51","author":"Harrigan","year":"2020","journal-title":"Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1007\/s10143-025-03460-x","article-title":"Traumatic vertebral artery occlusion is associated with high rates of recanalization: Insights from a systematic review and meta-analysis","volume":"48","author":"Sujijantarat","year":"2025","journal-title":"Neurosurg. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"522","DOI":"10.3171\/2023.5.JNS222818","article-title":"Traumatic vertebral artery injury: Denver grade, bilaterality, and stroke risk. A systematic review and meta-analysis","volume":"140","author":"Michalopoulos","year":"2024","journal-title":"J. Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","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","journal-title":"Ann. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1007\/s00701-010-0685-7","article-title":"Blunt craniocervical artery injury in cervical spine lesions: The value of ct angiography","volume":"152","author":"Fleck","year":"2010","journal-title":"Acta Neurochir. (Wien)"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1177\/21925682221137823","article-title":"The incidence, characteristics and outcomes of vertebral artery injury associated with cervical spine trauma: A systematic review","volume":"13","author":"Temperley","year":"2023","journal-title":"Glob. Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1177\/23969873231226029","article-title":"High pillow and spontaneous vertebral artery dissection: A case-control study implicating \u201cshogun pillow syndrome\u201d","volume":"9","author":"Egashira","year":"2024","journal-title":"Eur. Stroke J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e672","DOI":"10.1016\/j.wneu.2019.06.187","article-title":"Risk of vertebral artery injury and stroke following blunt and penetrating cervical spine trauma: A retrospective review of 729 patients","volume":"130","author":"AlBayar","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Zygogiannis, K., Benetos, I.S., Evangelopoulos, D.S., Koulalis, D., and Pneumaticos, S.G. (2024). Blunt traumatic vertebral artery injury after cervical fracture dislocation: A systematic review of the literature. Cureus, 16.","DOI":"10.7759\/cureus.65250"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1097\/01.TA.0000092700.92587.32","article-title":"Cervical spine fracture patterns predictive of blunt vertebral artery injury","volume":"55","author":"Cothren","year":"2003","journal-title":"J. Trauma"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1016\/j.spinee.2022.05.009","article-title":"Cervical fracture patterns associated with blunt cerebrovascular injures when utilizing computed tomographic angiography: A systematic review and meta-analysis","volume":"22","author":"Du","year":"2022","journal-title":"Spine J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"11","DOI":"10.4103\/0974-8237.110118","article-title":"Mechanism and patterns of cervical spine fractures-dislocations in vertebral artery injury","volume":"3","author":"Gupta","year":"2012","journal-title":"J. Craniovertebr. Junction Spine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.ejrad.2007.01.008","article-title":"Angiographic frequency of blunt cerebrovascular injury in patients with carotid canal or vertebral foramen fractures on multidetector ct","volume":"62","author":"McKinney","year":"2007","journal-title":"Eur. J. Radiol."},{"key":"ref_16","first-page":"89","article-title":"Vertebral artery injury in cervical spine fractures: A cohort study and review of the literature","volume":"89","author":"R","year":"2020","journal-title":"Ulster Med. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1227\/00006123-199403000-00008","article-title":"The incidence of vertebral artery injury after midcervical spine fracture or subluxation","volume":"34","author":"Willis","year":"1994","journal-title":"Neurosurgery"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E713","DOI":"10.1097\/BRS.0000000000000893","article-title":"Predictors of vertebral artery injury in isolated c2 fractures based on fracture morphology using ct angiography","volume":"40","author":"Durand","year":"2015","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"490","DOI":"10.3171\/2015.6.SPINE15140","article-title":"Screening via ct angiogram after traumatic cervical spine fractures: Narrowing imaging to improve cost effectiveness. Experience of a level i trauma center","volume":"24","author":"Lockwood","year":"2016","journal-title":"J. Neurosurg. Spine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1007\/s00701-012-1499-6","article-title":"Vertebral artery injury in destabilized midcervical spine trauma; predisposing factors and proposed mechanism","volume":"154","author":"Chung","year":"2012","journal-title":"Acta Neurochir. (Wien)"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"27","DOI":"10.4103\/jcvjs.jcvjs_3_22","article-title":"Vertebral artery dissection in acute cervical spine trauma","volume":"13","author":"Gupta","year":"2022","journal-title":"J. Craniovertebr. Junction Spine"},{"key":"ref_22","first-page":"427","article-title":"Direct damage to a vertebral artery better predicts a vertebral artery injury than elongation in cervical spine dislocation","volume":"71","author":"Nagata","year":"2017","journal-title":"Acta Med. Okayama"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"E957","DOI":"10.1097\/BRS.0b013e31818e2f31","article-title":"Does the morphology of foramen transversarium fractures predict vertebral artery injuries?","volume":"33","author":"Oetgen","year":"2008","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"410","DOI":"10.4103\/jcvjs.jcvjs_111_22","article-title":"Concomitant cervical spine fractures are the primary driver of disability after traumatic vertebral artery dissection: A case series of 123 patients","volume":"13","author":"Cloney","year":"2022","journal-title":"J. Craniovertebr. Junction Spine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/S0002-9610(99)00245-7","article-title":"Optimizing screening for blunt cerebrovascular injuries","volume":"178","author":"Biffl","year":"1999","journal-title":"Am. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1097\/00005373-200108000-00013","article-title":"Liberalized screening for blunt carotid and vertebral artery injuries is justified","volume":"51","author":"Kerwin","year":"2001","journal-title":"J. Trauma"},{"key":"ref_27","first-page":"1333","article-title":"Blunt vertebral artery injuries in the era of computed tomographic angiographic screening: Incidence and outcomes from 8,292 patients","volume":"67","author":"Berne","year":"2009","journal-title":"J. Trauma"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1097\/01.ta.0000220435.55791.ce","article-title":"Sixteen-slice multi-detector computed tomographic angiography improves the accuracy of screening for blunt cerebrovascular injury","volume":"60","author":"Berne","year":"2006","journal-title":"J. Trauma"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1097\/01.ta.0000204034.94034.c4","article-title":"Sixteen-slice computed tomographic angiography is a reliable noninvasive screening test for clinically significant blunt cerebrovascular injuries","volume":"60","author":"Biffl","year":"2006","journal-title":"J. Trauma"},{"key":"ref_30","first-page":"691","article-title":"Screening for blunt cerebrovascular injury: Evaluating the accuracy of multidetector computed tomographic angiography","volume":"59","author":"Bub","year":"2005","journal-title":"J. Trauma"},{"key":"ref_31","doi-asserted-by":"crossref","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","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1097\/SLA.0b013e3181568cab","article-title":"Computed tomographic angiography for the diagnosis of blunt carotid\/vertebral artery injury: A note of caution","volume":"246","author":"Malhotra","year":"2007","journal-title":"Ann. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1097\/00007632-199404000-00019","article-title":"A simple method for diagnosing traumatic occlusion of the vertebral artery at the craniovertebral junction","volume":"19","author":"Song","year":"1994","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1016\/j.jamcollsurg.2006.08.003","article-title":"Sixteen-slice ct angiography in patients with suspected blunt carotid and vertebral artery injuries","volume":"203","author":"Utter","year":"2006","journal-title":"J. Am. Coll. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.2106\/JBJS.18.00107","article-title":"The clinical implications of adding ct angiography in the evaluation of cervical spine fractures: A propensity-matched analysis","volume":"100","author":"Tobert","year":"2018","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jvs.2009.08.071","article-title":"A multivariate logistic regression analysis of risk factors for blunt cerebrovascular injury","volume":"51","author":"Berne","year":"2010","journal-title":"J. Vasc. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"E520","DOI":"10.1097\/BRS.0000000000002420","article-title":"Indications for ct-angiography of the vertebral arteries after trauma","volume":"43","author":"Drain","year":"2018","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.3171\/2020.8.JNS202589","article-title":"Derivation and validation of a quantitative screening model for blunt cerebrovascular injury","volume":"135","author":"Shibahashi","year":"2021","journal-title":"J. Neurosurg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s10140-019-01677-0","article-title":"Augmenting denver criteria yields increased bcvi detection, with screening showing markedly increased risk for subsequent ischemic stroke","volume":"26","author":"Bensch","year":"2019","journal-title":"Emerg. Radiol."},{"key":"ref_40","first-page":"1058","article-title":"Improving the screening criteria for blunt cerebrovascular injury: The appropriate role for computed tomography angiography","volume":"70","author":"Emmett","year":"2011","journal-title":"J. Trauma"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1016\/j.amjsurg.2016.09.016","article-title":"Expanded screening criteria for blunt cerebrovascular injury: A bigger impact than anticipated","volume":"212","author":"Geddes","year":"2016","journal-title":"Am. J. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1055\/s-0036-1579552","article-title":"Blunt cerebrovascular injury in cervical spine fractures: Are more-liberal screening criteria warranted?","volume":"6","author":"Grabowski","year":"2016","journal-title":"Glob. Spine J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s13017-015-0040-7","article-title":"The limitations of using risk factors to screen for blunt cerebrovascular injuries: The harder you look, the more you find","volume":"10","author":"Jacobson","year":"2015","journal-title":"World J. Emerg. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1177\/00031348211011141","article-title":"Above the clavicle: A simplified screening method for asymptomatic blunt cerebral vascular injury","volume":"89","author":"McCullough","year":"2023","journal-title":"Am. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1917","DOI":"10.1016\/j.injury.2017.06.006","article-title":"Increased detection of blunt carotid and vertebral artery injury after implementation of diagnostic imaging pathway in level 1 trauma centre in western australia","volume":"48","author":"Sinnathamby","year":"2017","journal-title":"Injury"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1177\/21925682231209631","article-title":"A systematic review and meta-analysis of vertebral artery injury after cervical spine trauma","volume":"14","author":"Goyal","year":"2024","journal-title":"Glob. Spine J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.clineuro.2017.07.005","article-title":"The diagnostic accuracy of magnetic resonance angiography for blunt vertebral artery injury detection in trauma patients: A systematic review and meta-analysis","volume":"160","author":"Karagiorgas","year":"2017","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"443","DOI":"10.2214\/ajr.164.2.7839986","article-title":"Vertebral artery injury after acute cervical spine trauma: Rate of occurrence as detected by mr angiography and assessment of clinical consequences","volume":"164","author":"Friedman","year":"1995","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_49","doi-asserted-by":"crossref","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","journal-title":"Ann. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1097\/01.brs.0000176186.64276.d4","article-title":"Traumatically induced vertebral artery occlusion associated with cervical spine injuries: Prospective study using magnetic resonance angiography","volume":"30","author":"Taneichi","year":"2005","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1097\/00005373-199904000-00017","article-title":"Detection of vertebral artery injury after cervical spine trauma using magnetic resonance angiography","volume":"46","author":"Weller","year":"1999","journal-title":"J. Trauma"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1272\/jnms.74.293","article-title":"Significance of magnetic resonance imaging in the diagnosis of vertebral artery injury associated with blunt cervical spine trauma","volume":"74","author":"Yokota","year":"2007","journal-title":"J. Nippon Med. Sch."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Ishimoto, Y., Iwasaki, H., Sonekatsu, M., Murata, S., Kozaki, T., Hashizume, H., Tsutsui, S., Takami, M., Nagata, K., and Hira, K. (2023). Ultrasonography is an effective tool for the evaluation of traumatic vertebral artery injuries distal to fourth cervical vertebra in the emergency room. BMC Musculoskelet. Disord., 24.","DOI":"10.1186\/s12891-023-06426-6"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.7863\/ultra.32.6.1023","article-title":"A novel decision tree approach based on transcranial doppler sonography to screen for blunt cervical vascular injuries","volume":"32","author":"Purvis","year":"2013","journal-title":"J. Ultrasound Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1642","DOI":"10.3171\/2017.2.JNS163264","article-title":"Limitations of multidetector computed tomography angiography for the diagnosis of blunt cerebrovascular injury","volume":"128","author":"Grandhi","year":"2018","journal-title":"J. Neurosurg."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Yi, Z., Vankawala, J., Koneru, M., Oliveira, R., Santucci, J., Morse, C., Ifrach, J., Al-Atrache, Z., Fox, N.M., and Goldenberg-Sandau, A. (2025). Change in management for digital subtraction angiography-identified false-positive traumatic vertebral artery injury. Interv Neuroradiol.","DOI":"10.1177\/15910199241312254"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/j.amjsurg.2005.08.007","article-title":"Screening for blunt cerebrovascular injuries is cost-effective","volume":"190","author":"Cothren","year":"2005","journal-title":"Am. J. Surg."},{"key":"ref_58","first-page":"1051","article-title":"Screening for blunt cerebrovascular injuries is cost-effective","volume":"70","author":"Kaye","year":"2011","journal-title":"J. Trauma"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"111319","DOI":"10.1016\/j.injury.2024.111319","article-title":"Prognostic factors associated with risk of stroke following blunt cerebrovascular injury: A systematic review and meta-analysis","volume":"55","author":"Tran","year":"2024","journal-title":"Injury"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1097\/TA.0000000000002660","article-title":"New ischemic lesions on brain magnetic resonance imaging in patients with blunt traumatic cerebrovascular injury","volume":"88","author":"Harrigan","year":"2020","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1038\/sc.2014.145","article-title":"Posterior circulation infarction in patients with traumatic cervical spinal cord injury and its relationship to vertebral artery injury","volume":"53","author":"Belci","year":"2015","journal-title":"Spinal Cord"},{"key":"ref_62","first-page":"2645","article-title":"Incidence of vertebral artery thrombosis in cervical spine trauma: Correlation with severity of spinal cord injury","volume":"26","author":"Torina","year":"2005","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1111\/j.1747-4949.2012.00954.x","article-title":"Predictors of delayed stroke in patients with cervical artery dissection","volume":"10","author":"Lichy","year":"2015","journal-title":"Int. J. Stroke"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.avsg.2018.05.034","article-title":"Limited clinical relevance of vertebral artery injury in blunt trauma","volume":"53","author":"Lytle","year":"2018","journal-title":"Ann. Vasc. Surg."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1007\/s10140-011-0981-4","article-title":"Cervical collaterals may protect against stroke after blunt vertebral artery injury","volume":"18","author":"Fink","year":"2011","journal-title":"Emerg. Radiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1097\/TA.0000000000003455","article-title":"Factors associated with stroke formation in blunt cerebrovascular injury: An east multicenter study","volume":"92","author":"Esposito","year":"2022","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_67","doi-asserted-by":"crossref","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","journal-title":"Ann. Surg."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1097\/TA.0000000000000418","article-title":"Early repeat imaging is not warranted for high-grade blunt cerebrovascular injuries","volume":"77","author":"Wagenaar","year":"2014","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.3171\/2014.9.JNS1461","article-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","volume":"122","author":"Scott","year":"2015","journal-title":"J. Neurosurg."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1016\/j.jvs.2018.09.051","article-title":"Follow-up imaging of traumatic vertebral artery dissections is unnecessary in asymptomatic patients","volume":"69","author":"Nally","year":"2019","journal-title":"J. Vasc. Surg."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.avsg.2023.10.022","article-title":"Analysis of extracranial cerebrovascular injuries: Clinical predictors of management and outcomes","volume":"100","author":"Boggs","year":"2024","journal-title":"Ann. Vasc. Surg."},{"key":"ref_72","doi-asserted-by":"crossref","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","journal-title":"J. Neurosurg."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e838","DOI":"10.1016\/j.wneu.2019.06.046","article-title":"Prevention of thromboembolic infarction after surgery for traumatic cervical fracture with vertebral artery occlusion by preoperative endovascular coil embolization","volume":"129","author":"Indo","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"3392","DOI":"10.1007\/s00586-022-07302-y","article-title":"Safety of early posterior fusion surgery without endovascular embolization for asymptomatic vertebral artery occlusion associated with cervical spine trauma","volume":"31","author":"Asukai","year":"2022","journal-title":"Eur. Spine J."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1097\/00007632-200005010-00019","article-title":"Vertebral artery occlusion after acute cervical spine trauma","volume":"25","author":"Veras","year":"2000","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.wneu.2016.08.002","article-title":"Vertebral artery occlusion and recanalization after cervical facet dislocation","volume":"95","author":"Zhang","year":"2016","journal-title":"World Neurosurg."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/S1474-4422(21)00044-2","article-title":"Aspirin versus anticoagulation in cervical artery dissection (treat-cad): An open-label, randomised, non-inferiority trial","volume":"20","author":"Engelter","year":"2021","journal-title":"Lancet Neurol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1001\/jamaneurol.2019.0072","article-title":"Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection","volume":"76","author":"Markus","year":"2019","journal-title":"JAMA Neurol."},{"key":"ref_79","doi-asserted-by":"crossref","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","journal-title":"Arch. Surg."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/00005373-200108000-00009","article-title":"Blunt cerebrovascular injuries: Diagnosis and treatment","volume":"51","author":"Miller","year":"2001","journal-title":"J Trauma"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.avsg.2020.05.029","article-title":"Pharmacologic therapy is not associated with stroke prevention in patients with isolated blunt vertebral artery injury","volume":"70","author":"Pujari","year":"2021","journal-title":"Ann. Vasc. Surg."},{"key":"ref_82","first-page":"132","article-title":"Blunt cerebrovascular injuries: Does treatment always matter?","volume":"66","author":"Stein","year":"2009","journal-title":"J Trauma"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1227\/NEU.0000000000001843","article-title":"Blunt traumatic vertebral artery injuries: Incidence, therapeutic management, and outcomes","volume":"90","author":"Zeineddine","year":"2022","journal-title":"Neurosurgery"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"3702","DOI":"10.1016\/j.injury.2022.08.043","article-title":"Does treatment delay for blunt cerebrovascular injury affect stroke rate?: An east multicenter study","volume":"53","author":"Appelbaum","year":"2022","journal-title":"Injury"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"66","DOI":"10.14444\/7009","article-title":"Cervical spine decompression and fusion outcomes in trauma patients actively receiving anticoagulation treatment for cerebrovascular injury: A retrospective comparative study","volume":"14","author":"Camillo","year":"2020","journal-title":"Int. J. Spine Surg."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1097\/TA.0000000000002668","article-title":"Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the eastern association for the surgery of trauma","volume":"88","author":"Kim","year":"2020","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1097\/00000658-199810000-00003","article-title":"The unrecognized epidemic of blunt carotid arterial injuries: Early diagnosis improves neurologic outcome","volume":"228","author":"Biffl","year":"1998","journal-title":"Ann. Surg."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1097\/00005373-199812000-00004","article-title":"Blunt vascular injuries of the head and neck: Is heparinization necessary?","volume":"45","author":"Eachempati","year":"1998","journal-title":"J. Trauma"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1097\/00000658-199605000-00007","article-title":"Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy","volume":"223","author":"Fabian","year":"1996","journal-title":"Ann. Surg."},{"key":"ref_90","first-page":"896","article-title":"Antiplatelet therapy: An alternative to heparin for blunt carotid injury","volume":"52","author":"Wahl","year":"2002","journal-title":"J. Trauma"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.avsg.2023.10.023","article-title":"Medical management of traumatic vertebral artery injury is safe regardless of the severity of injury","volume":"101","author":"Boggs","year":"2024","journal-title":"Ann. Vasc. Surg."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1097\/TA.0b013e318243d978","article-title":"Early treatment of blunt cerebrovascular injury with concomitant hemorrhagic neurologic injury is safe and effective","volume":"72","author":"Callcut","year":"2012","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1007\/s00701-014-2074-0","article-title":"Individualized endovascular treatment of high-grade traumatic vertebral artery injury","volume":"156","author":"Mei","year":"2014","journal-title":"Acta Neurochir. (Wien)"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jocn.2016.03.023","article-title":"Vertebral artery pseudoaneurysms secondary to blunt trauma: Endovascular management by means of neurostents and flow diverters","volume":"32","author":"Cohen","year":"2016","journal-title":"J. Clin. Neurosci."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1227\/NEU.0b013e318209ce03","article-title":"Endovascular stenting of extracranial carotid and vertebral artery dissections: A systematic review of the literature","volume":"68","author":"Pham","year":"2011","journal-title":"Neurosurgery"},{"key":"ref_96","first-page":"886","article-title":"Therapeutic endovascular treatments for traumatic vertebral artery injuries","volume":"62","author":"Lee","year":"2007","journal-title":"J. Trauma"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1136\/neurintsurg-2016-012565","article-title":"Stroke prevention by endovascular treatment of carotid and vertebral artery dissections","volume":"9","author":"Moon","year":"2017","journal-title":"J. Neurointerv. Surg."},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Merrill, S., Clifton, W., Valero-Moreno, F., Damon, A., and Rahmathulla, G. (2020). Vertebral artery injury with coinciding unstable cervical spine trauma: Mechanisms, evidence-based management, and treatment options. Cureus, 12.","DOI":"10.7759\/cureus.7225"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"131","DOI":"10.2176\/nmccrj.cr.2018-0330","article-title":"Efficacy of endovascular proximal occlusion before direct reposition surgery of blunt cervical fracture with unilateral vertebral injury","volume":"6","author":"Isaji","year":"2019","journal-title":"NMC Case Rep. J."},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Nakamura, Y., Kusakabe, K., Nakao, S., Hagihara, Y., and Matsuoka, T. (2021). Vertebral artery occlusion associated with blunt traumatic cervical spine injury. Acute Med. Surg., 8.","DOI":"10.1002\/ams2.670"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.ejvs.2003.11.008","article-title":"Management of extra-cranial vertebral artery injuries","volume":"27","author":"Mwipatayi","year":"2004","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"577","DOI":"10.2214\/ajr.153.3.577","article-title":"Interventional neurovascular treatment of traumatic carotid and vertebral artery lesions: Results in 234 cases","volume":"153","author":"Higashida","year":"1989","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s002689900191","article-title":"Evaluation of penetrating injuries of the neck: Prospective study of 223 patients","volume":"21","author":"Demetriades","year":"1997","journal-title":"World J. Surg."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/S0741-5214(00)70063-2","article-title":"Surgical reconstruction of the extracranial vertebral artery: Management and outcome","volume":"31","author":"Berguer","year":"2000","journal-title":"J. Vasc. Surg."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1067\/mva.2002.126092","article-title":"Distal vertebral artery reconstruction: Long-term outcome","volume":"36","author":"Kieffer","year":"2002","journal-title":"J. Vasc. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/9\/3159\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:26:29Z","timestamp":1760030789000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/9\/3159"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,2]]},"references-count":105,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcm14093159"],"URL":"https:\/\/doi.org\/10.3390\/jcm14093159","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,2]]}}}