RadEssentialReading-room reference
Blunt cerebrovascular injury (Denver/Biffl)
Grades blunt carotid and vertebral artery injury on CTA or DSA. Grade guides antithrombotic therapy versus endovascular/surgical management.
| Grade | Description |
|---|---|
| I | Luminal irregularity or dissection/intramural hematoma with <25% luminal narrowing |
| II | Dissection or intramural hematoma with ≥25% narrowing, intraluminal thrombus, or raised intimal flap |
| III | Pseudoaneurysm |
| IV | Occlusion |
| V | Transection with free extravasation |
Expanded Denver screening criteria
CTA is indicated if one or more are present.
| Group | Criteria |
|---|---|
| Signs / symptoms | Arterial hemorrhage from neck, nose or mouth · cervical bruit in patient <50 years · expanding cervical hematoma · focal neurologic deficit · neurologic exam incongruous with head CT · stroke on follow-up CT |
| Risk factors high-energy mechanism | Le Fort II or III · cervical spine fracture, subluxation or ligamentous injury at any level · mandible fracture · complex skull, skull base or occipital condyle fracture · severe TBI with GCS <6 · near hanging with anoxic brain injury · seat belt abrasion with significant swelling, pain or altered mental status · TBI with thoracic injury · scalp degloving · thoracic vascular injury · blunt cardiac rupture · upper rib fracture |
Pearls
- Look for associated cervical spine fractures through the transverse foramen, C1–C3 fractures, and skull base fractures through the carotid canal.
- Grade I–II injuries commonly progress or resolve; short-interval follow-up CTA is standard practice.
Sources
- Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Burch JM. Blunt carotid arterial injuries: implications of a new grading scale. J Trauma. 1999;47:845–853.PubMed ↗
- Geddes AE, Burlew CC, Wagenaar AE, et al. Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated. Am J Surg. 2016;212:1167–1174.PubMed ↗
Radessential summarizes published classification systems for practicing radiologists. Summaries are condensed; confirm details against the cited source before relying on them for patient care.