Blunt carotid and vertebral arterial injuries

Blunt carotid and vertebral arterial injuries are uncommon but have the pot ential for devastating consequences. The classic presentation is a neurolog ic deficit unexplained by computed tomographic scan findings. Screening pat ients based on injury mechanisms and patterns allows the diagnosis and trea tment of injuries while they are still asymptomatic, potentially improving neurologic outcomes. The development of a grading scale may help refine tre atment guidelines. Accessible grade II, III, and V carotid injuries should be repaired surgically. Anticoagulation should be considered first-line the rapy for grade I and IV, and inaccessible grade II and III carotid lesions, and grade I-IV vertebral injuries. Grade V and persistent grade III lesion s may be best treated employing endovascular techniques.