Figure 1: Treatment strategy for vertebral artery injury (VAI) in our institution.
In patients with cervical fracture or subluxation, CT angiography is performed to evaluate the carotid and vertebral artery injuries. Once the diagnosis of VAI is made, the VAI is graded based on the Denver grading system. For grade I to III injuries, antithrombotic therapy using heparin infusion aimed at a prothrombin time of 40 to 50 seconds is initiated unless contraindicated by co-morbid injuries. For grade IV injuries, the indications for urgent operation or reduction are evaluated. When these manipulations are planned, prophylactic embolization is considered to completely occlude the vertebral artery. Antithrombotic therapy is then started after the operation. In patients not undergoing urgent manipulations, antithrombotic therapy is administered.

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