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Denver criteria for blunt cerebrovascular injury

Dr Paresh K Desai and Dr Ki Yap et al.

The Denver Criteria illustrates the spectrum of blunt cerebrovascular Injury (BCVI) seen on angiography (CTA, DSA). This grading system has prognostic and therapeutic implications.

grade I : mild intimal injury or irregular intima.
grade II : dissection with raised intimal flap / intramural haematoma with luminal narrowing > 25% / intraluminal thrombosis
grade III : pseudoaneurysm
grade IV : vessel occlusion / thrombosis
grade V : vessel transection.

Clinical Implications

A grade I injury heals regardless of therapy. 70% of dissections or haematomas with luminal stenosis (grade II) progressed whilst on heparin therapy. Only 8% of pseudoaneurysms (grade III) healed with heparin, about 89% resolves after endovascular stenting. Occluded carotid arteries (grade IV) does not recanalize in the early post-injury period. Grade V injuries (transections) are lethal and refractory to intervention. Stroke risk increased with injury grade.