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P.172 Work-up and management of asymptomatic extracranial traumatic vertebral artery injury

Published online by Cambridge University Press:  24 June 2022

MA MacLean
Affiliation:
(Halifax)*
CJ Touchette
Affiliation:
(Sherbrooke)
T Dude
Affiliation:
(Hamilton)
A Almojuela
Affiliation:
(Winnipeg)
D Bergeron
Affiliation:
(Montreal)
M Kameda-Smith
Affiliation:
(Hamilton)
AR Persad
Affiliation:
(Saskatoon)
N Sader
Affiliation:
(Calgary)
J Alant
Affiliation:
(Halifax)
SD Christie
Affiliation:
(Halifax)
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Abstract

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Background: Extracranial traumatic vertebral artery injury (eTVAI) is common following non-penetrating head and neck trauma. Most cases are initially asymptomatic with an increased risk for stroke. Consensus is lacking regarding screening, treatment, and follow-up of asymptomatic patients with eTVAI. Our objective was to investigate national practice patterns reflecting these domains. Methods: An electronic survey was distributed via the Canadian Neurological Sciences Federation and Canadian Spine Society. Two case-based scenarios featured asymptomatic patients with eTVAI. Case 1: non-displaced cervical lateral mass fracture; angiography stratified by luminal diameter reduction. Case 2: complex C2 fracture; angiography featuring pseudoaneurysm dissection. Analysis: descriptive statistics. Results: Response Rate: 108 of 182 participants (59%), representing 20 academic institutions.

Case 1: 78% of respondents would screen using CTA (97%), immediately (88%). Most respondents (97%) would initiate treatment, using aspirin (89%) for 3-6 months (46%).

Case 2: 73% of respondents would screen using CTA (96%), immediately (88%). The majority of respondents (94%) would initiate treatment, using aspirin (50%) for 3-6 months (35%). Thirty-six percent of respondents would utilize endovascular therapy.

In both cases, the majority of respondents would follow-up clinically or radiographically every 1-3 months, respectively. Conclusions: This study highlights consensus in Canadian practice patterns for the workup and management of asymptomatic eTVAI.

Type
Poster Presentations
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation