The Incidence of Arterial Injury on CT Imaging in Cervical and Skull Base Fractures

Introduction: Blunt trauma to the head and cervical spine can result in vascular injury, particularly to the carotid and vertebral arteries. Computed tomography (CT) angiography is replacing conventional cerebrovascular angiography in the screening of trauma patients with suspected arterial injury. We were interested in investigating the incidence of CT-identified vascular injuries in skull base and/or cervical fracture patients. Methods: To assess the incidence of CT-identified arterial injury, a retrospective review was conducted of traumatic cervical and skull base fracture patients at a level I trauma center from January 2015 to September 2021. Results: 726 total patients were identified. 50 patients were excluded for insufficient imaging data. 17 patients (6 with skull base fractures, 10 with cervical fractures, and 1 with both cervical and skull base fractures) received a non-CT imaging modality and were excluded. None had arterial injuries. 659 total patients received CT imaging, 422 with CT-imaged cervical fractures, 213 with CT-imaged skull base fractures, and 24 with CT-imaged cervical and skull base fractures. Of the 422 CT-imaged cervical fractures, 2 had carotid artery injuries, 20 had vertebral artery injuries, and 4 had both carotid artery and vertebral artery injuries. Of the 213 CT-imaged skull base fractures, 2 had carotid artery injuries and 2 had vertebral artery injuries. One of the 24 CT-imaged patients with both cervical and skull base fractures had vertebral artery injury. Conclusion: The incidence of CT-identified arterial injury was 6.16% in cervical fracture patients, 1.88% in skull base fracture patients, and 4.17% in patients with both cervical and skull base fractures. While CT-identified arterial injuries were noted, the incidence was low overall, although it appears higher in the setting of cervical, as compared to skull base, fractures. Future studies will assess the characteristics, screening, and outcomes of cervical and skull base fracture patients with arterial injuries.