Incidence of traumatic carotid and vertebral artery dissections: results of cervical vessel computed tomography angiogram as a mandatory scan component in severely injured patients

Figures & data

Figure 1 Age distribution of multiply injured patients without blunt injury of the cervical arteries (control), with CAD, and with VAD.

Abbreviations: CAD, carotid artery dissection; VAD, vertebral artery dissection.

Table 1 Data on patients, injury severity, and mortality

	Control	CAD	VAD
N	215	12	4
Age, years (median, range)	41.8 (1.9–90.9)	52.7 (18.0–79.9)	44.9 (22.6–63.3)
Sex (m/f)	155/59	7/5	3/1
ISS (median; range)	25; 13–75	34; 17–57	39.5; 22–57
Major bleeding	31 (14.4%)	1 (8.3%)	1 (25%)
Mortality	24 (11.2%)	3 (25%)	1 (25%)

Abbreviations: CAD, carotid artery dissection; f, female; ISS, Injury Severity Score; m, male; VAD, vertebral artery dissection.

Figure 2 Trauma mechanism of multiply injured patients without blunt injury of the cervical arteries (control), with CAD, and with VAD.

Abbreviations: CAD, carotid artery dissection; VAD, vertebral artery dissection.

Figure 3 Trauma severity measured by ISS of multiply injured patients without blunt injury of the cervical arteries (control), with CAD, and with VAD.

Note: Values are shown as mean ± SD.
Abbreviations: CAD, carotid artery dissection; ISS, Injury Severity Score; VAD, vertebral artery dissection.

Table 2 Concomitant injuries

Injury	Control	CAD	VAD
Cervical spine fracture	42 (19.5)	4 (33.3)	4 (100)*
Thoracic spine fracture	56 (26)	4 (33.3)	0 (0)
Lumbar spine fracture	44 (20.5)	4 (33.3)	1 (33.3)
Midface and skull fractures	91 (42.3)	5 (41.7)	2 (50)
Rib fractures	107 (49.8)	3 (25)	2 (50)
Pelvic ring fracture	57 (26.5)	5 (41.7)	1 (33.3)
Upper extremity fracture	72 (33.5)	5 (41.7)	1 (33.3)
Lower extremity fracture	59 (27.4)	6 (50)	1 (33.3)
Traumatic brain injury	140 (65.1)	6 (50)	3 (75)
Lung injury	120 (55.8)	6 (50)	2 (66.6)
Abdominal organ injury	59 (27.4)	4 (33.3)	2 (66.6)

Notes: Absolute values, percentage in parenthesis.

* P<0.05 vs control (statistically significant).

Abbreviations: CAD, carotid artery dissection; VAD, vertebral artery dissection.

Figure 4 Image of traumatic carotid artery dissection on the right side.

Notes: (A) Axial polytrauma CT clearly depicts the dissection membrane in the right internal carotid artery (arrow). (B) No flow (arrow) can be seen distal of the CAD right before entering of the carotid artery into the petrous bone. (C) PD fs axial MRI sequence, acquired 1 week later, shows the right-sided CAD revealing the hyperdense carotid wall hematoma (arrow).
Abbreviations: CAD, carotid artery dissection; CT, computed tomography; MRI, magnetic resonance imaging; PD fs axial, axial fat-saturated proton density.

Figure 5 Bilateral vertebral artery dissection in cervical C5/6 facet fractures with dislocation.

Notes: (A) No flow in the vertebral arteries from C5 to C7 (connected arrows). B delineates plane of axial CT image B. (B) Axial CT image shows no flow in both vertebral arteries (arrows).
Abbreviation: CT, computed tomography.