UMEM Educational Pearls

Category: Critical Care

Title: Blunt Vascular Injury

Keywords: blunt trauma, vascular inury, anticoagulation, thrombosis, emboli (PubMed Search)

Posted: 1/3/2012 by Haney Mallemat, MD
Click here to contact Haney Mallemat, MD

Carotid or vertebral artery injury following blunt trauma is a rare (%1 of blunt trauma), but a potentially serious injury potentially causing stroke and long-term disability.

Injury leads to an intimal tear becoming a nidus for platelet aggregation; thrombosis and/or distal emboli may subsequently develop.

Mechanisms of injury include:

  • Blunt trauma to the neck
  • Hyper-extension of neck with contralateral rotation of the head
  • Intra-oral trauma
  • Arterial laceration secondary to adjacent sphenoid or petrous bone fracture.

Symptoms of carotid injury may include contralateral sensorimotor deficits; Symptoms of vertebral injury may include ipsilateral facial pain and numbness, headache, ataxia, or dizziness.

Angiography is the diagnostic “gold standard” but these days a 16-slice CT angiography (or greater) is a reliable screening tool.

Anticoagulation with heparin is the treatment of choice for severe injury, if there are no contraindications (e.g., intracranial bleeding). Anti-platelet drugs may be acceptable in certain cases.


Kim YK, Schulman S. Cervical artery dissection: pathology, epidemiology and management. Thromb Res. Apr 2009;123(6):810-21.

Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. Mar 22 2001;344(12):898-906. 

Follow me on Twitter (@criticalcarenow) or Google+ (+haney mallemat)