0:01

Before we talk about the scale for

0:04

looking at blunt vascular injury,

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I did want to go through this quick collage of the

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different findings that you can see associated

0:12

with internal carotid artery or common

0:14

carotid artery dissection.

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Here what we see is the narrowing of the internal

0:19

carotid artery as well as the lowdensity

0:22

wall hematoma. In the dissection.

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Here we see the flap of the dissection with 2

0:30

upper middle image here we see reduction in the

0:35

luminal diameter of the internal choroid artery

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compared with the left internal choroid artery

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as well as a laterally projecting wall clot.

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And on the MRI scan we see that in this case the

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luminal diameter actually is, if anything,

0:52

a little bit larger than the contralateral side.

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But there is wall hematoma.

0:57

This is a fat sat t one.

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Weighted scan where the lumen is normal,

1:03

but the wall shows abnormal signal

1:06

intensity in this dissection.

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And just a reminder that with these dissections,

1:11

you can have a potential pseudo

1:14

aneurysm formation.

1:15

You see the narrowing of the carotid artery lumen

1:18

and dissection with the pseudo aneurysm.

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Now, the previous slide, I believe,

1:23

had said that only 5% of cases showed development

1:28

of pseudo aneurysms. However, this is a paper.

1:32

In 2016,

1:34

they looked at 370 patients with carotid

1:37

and vertebral artery dissections.

1:39

And of those they report,

1:41

30% developed one or more pseudo aneurysms,

1:45

and they were more common in the carotid

1:47

artery than in the vertebral artery.

1:49

So that's the range that you can see

1:51

in the literature from 5% to 30%.

1:54

A pretty broad range, I might add.

1:56

So let's talk about the scale that we use

1:59

for looking. At neurovascular injury.

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This is what's known as the bifil scale.

2:05

And grade one has irregularity with

2:09

only less than 25% stenosis.

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Grade two is a dissection with greater than 25%

2:17

luminal narrowing or a visible intimal flap.

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Grade three is pseudo aneurysm.

2:23

Grade four is complete occlusion,

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and grade five is transection

2:27

with contrast extravasation.

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I've actually shown you examples of each of these.

2:32

The active contrast extravasation in that lower

2:35

left neck aneurysm in the patient

2:38

who had miliory TB.

2:39

We saw one where the blood vessel was completely

2:42

occluded. We've seen pseudo aneurysms,

2:45

we've seen in the previous slide, the flap,

2:48

and we've seen one where are the luminal diameters

2:51

greater than 25% narrowed versus those where it's

2:55

less than 25% narrowed. This is the so called.

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Scale for Blunt Cerebrovascular injury.