Traumatic occlusion of the vertebral artery occurs in up to 19.7% of patients with cervical spine injury. While ischemic stroke has been associated with this injury, data are lacking regarding the risk of ischemic stroke in the setting of traumatic vertebral artery (VA) occlusion with an operative spine injury. This study analyzed risk factors associated with ischemic stroke in patients with blunt traumatic VA occlusion.

This retrospective study included 52 patients with VA occlusion due to high energy blunt trauma. All injuries were assessed with thin-slice CT, with or without MRI. Management of the cervical spine injury was determined by the spine surgery staff. All subjects were treated with daily aspirin at 325 mg per day unless contraindicated.

Of the 52 patients, 10 suffered an ischemic stroke attributable to the VA occlusion, with seven of the strokes symptomatic and two resulting in death. Those who sustained strokes were significantly older (P＝0.042) and had a lower rate of spine surgery (10% with stroke, and 61% without stroke, P<0.05). Multivariate logistic regression demonstrated fewer ischemic strokes in patients treated with spine surgery (P＝0.014). Increasing age and bilateral VA injury were associated with increased risk of ischemic stroke (P＝0.065 and P＝0.084, respectively).

This study of patients with traumatic vertebral artery occlusion found a high risk of ischemic stroke, with an increased risk among patients with advanced age and a decreased risk among those undergoing cervical spine surgery.