PODCAST: Trauma Blunt Cardiovascular Injuries (BCVI)

Aug 31, 2026

Contributor: Aaron Lessen, MD

Educational Pearls:

 Blunt cerebrovascular injury (BCVI)

• BCVI is a traumatic injury to the carotid or vertebral arteries

  • Patients may initially have no neurologic symptoms

  • In some cases, a thrombus can form at the site of the injury and later cause ischemic stroke, sometimes hours after the original trauma

• CT angiography (CTA) of the neck is a useful screening tool for BCVI

  • HIstorically, CTA was reserved for patients with high-risk mechanisms or neurologic symptoms

  • CTA screening has expanded as understanding of BCVIs and their prevention progresses

• The Denver criteria were developed to identify patients with increased risk for BCVI

  • High-risk findings include cervical spine injuries and severe facial or skull-base fractures

  • Screening practices still vary between trauma centers, though expansion of proactive CTA is an increasingly common practice

References

1. Kim DY, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020.

2. Biffl WL, et al. Screening for and treatment of blunt cerebrovascular injuries: Western Trauma Association critical decisions algorithm. J Trauma. 2009.

3. Brommeland T, et al. Best practice guidelines for blunt cerebrovascular injury. Scand J Trauma Resusc Emerg Med. 2018.

4. Harper PR, et al. Routine CTA screening identifies blunt cerebrovascular injuries missed by clinical risk factors. Trauma Surg Acute Care Open. 2022.