Biffl scale for blunt cerebrovascular injury
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The Biffl scale or grade illustrates the spectrum of blunt cerebrovascular injury (BCVI) seen on angiography (both CTA and DSA). Some authors refer to the grading scale as the Denver scale, which is not to be confused with the Denver criteria, a set of clinical and risk factors for BCVI.
Classification
- 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
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grade V: vessel transection
.
Treatment and prognosis
This grading system has prognostic and therapeutic implications. Stroke risk increased with injury grade, the lower the grade, the better the prognosis 1.
- grade I: heals regardless of therapy
- grade II: 70% of dissections or
haematomeshaematomas with luminal stenosis progressed while on heparin therapy - grade III: only ~8% of
pseduoaneurysmspseudoaneurysms healed withheparingheparin and ~90% resolved after stenting - grade IV: occluded carotid arteries did not recanalise in the early post-injury period
- grade V: transections are lethal and refractory to therapy
-<strong>grade V</strong>: vessel transection.</li>-</ul><h4>Treatment and prognosis</h4><p>This grading system has prognostic and therapeutic implications. Stroke risk increased with injury grade, the lower the grade the better the prognosis <sup>1</sup>.</p><ul>- +<strong>grade V</strong>: vessel transection</li>
- +</ul><h4>Treatment and prognosis</h4><p>This grading system has prognostic and therapeutic implications. Stroke risk increased with injury grade, the lower the grade, the better the prognosis <sup>1</sup>.</p><ul>
-<li>grade II: 70% of dissections or haematomes with luminal stenosis progressed while on heparin therapy</li>-<li>grade III: only % of pseduoaneurysms healed with heparing and ~90% resolved after stenting</li>- +<li>grade II: 70% of dissections or haematomas with luminal stenosis progressed while on heparin therapy</li>
- +<li>grade III: only ~8% of pseudoaneurysms healed with heparin and ~90% resolved after stenting</li>
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