Management of Vertebral Artery Injuries Following Non-Penetrating Cervical Trauma

Publication Date: December 1, 2013
Last Updated: March 14, 2022



Computed tomographic angiography (CTA) is recommended as a screening tool in selected patients after blunt cervical trauma who meet the modified Denver Screening Criteria for suspected vertebral artery injury (VAI). (Level I)
Conventional catheter angiography is recommended for the diagnosis of VAI in selected patients after blunt cervical trauma, particularly if concurrent endovascular therapy is a potential consideration, and can be undertaken in circumstances in which CTA is not available. (Level III)
Magnetic resonance imaging is recommended for the diagnosis of VAI after blunt cervical trauma in patients with a complete spinal cord injury or vertebral subluxation injuries. (Level III)


It is recommended that the choice of therapy for patients with VAI—anticoagulation therapy vs antiplatelet therapy vs no treatment—be individualized based on the patient’s vertebral artery injury, the associated injuries, and the risk of bleeding. (Level III)
The role of endovascular therapy in VAI has yet to be defined; therefore, no recommendation regarding its use in the treatment of VAI can be offered. (Level III)

Recommendation Grading




Management of Vertebral Artery Injuries Following Non-Penetrating Cervical Trauma

Authoring Organization

Publication Month/Year

December 1, 2013

Last Updated Month/Year

January 12, 2023

Document Type


External Publication Status


Country of Publication


Document Objectives

Specific questions that were addressed include: the clinical and radiographic criteria used to prompt diagnostic evaluation, appropriate diagnostic tests for identifying vertebral artery injury (VAI), the treatment of VAI (observation compared to anticoagulation with heparin or to aspirin therapy), and the potential role of endovascular techniques for patients with VAI.

Target Patient Population

Patients with vertebral artery injury

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D000925 - Anticoagulants, D002561 - Cerebrovascular Disorders, D066193 - Cervical Cord, D014711 - Vertebral Artery, D002574 - Cervical Vertebrae, D020214 - Cerebrovascular Trauma, D000072226 - Computed Tomography Angiography


angiogram, computed tomographic imaging (CT), vertebral artery injuries

Source Citation

Neurosurgery, Volume 72, Issue suppl_3, March 2013, Pages 234–243,