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.
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.
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