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©2013 UpToDate ® Print Email Blunt cerebrovascular injury algorithm BCVI: blunt cerebrovascular injury; OR: operating room; TIA: transient ischemic attack; GCS: Glasgow coma scale; CT: computed tomography; CTA: computed tomographic angiography; MRI: magnetic resonance imaging; PTT: partial thromboplastin time; CHI: closed head injury; DAI: diffuse axonal injury; MS: mental status. * For positive arteriogram, follow treatment algorithm as per 16-slice CTA results (E and F). • CT angiography with multidetector-row CT, 16-channel or higher. If fewer than 16 channels, interpret CTA with caution. Δ If signs/symptoms or high clinical suspicion and (-)CTA, consider arteriogram as the gold standard. ◊ If Grade II-V injury is surgically accessible and patient has not suffered completed stroke, pursue operative repair. § Heparin is preferred in the acute setting, as it is reversible and may be more efficacious than antiplatelet drugs. Anticoagulation may be contraindicated due to other injuries. ¥ Stenting should be performed with caution, and appropriate antithrombotic therapy administered concurrently. ‡ Aspirin alone (75-150 mg daily) is adequate and should be considered lifelong as its risk profile is superior to coumadin. Reproduced with permission from: Biffl WL, Cothren CC, Moore EE, et al. Western Trauma Association critical decisions in trauma: screening for and treatment of blunt cerebrovascular injuries. J Trauma 2009; 67:1150. Copyright © 2009 Lippincott Williams & Wilkins.