SRS269 - Blunt neck trauma: a systematic review of delayed carotid artery dissection

Abstract Aim Cervical artery dissection (CAD) following blunt neck trauma is a rare but potentially devastating event, often presenting with delayed symptoms that complicate diagnosis and management. This systematic review aims to characterise the timeline and clinical features of delayed presentation of CAD. Methods A systematic search of MedLine, EMBASE, and Cochrane CENTRAL was conducted, supplemented by manual reference screening. Studies were included if they described blunt cervical trauma, confirmed CAD, and symptom onset >24 h post -injury. Eligible designs included RCTs, observational studies, and case reports. Results Twenty -six studies met the inclusion criteria, comprising 36 cases—primarily case reports and series. Patients ranged from 5 to 60 years; 57% were female. High -energy trauma was common, with initial loss of consciousness in 33%. Time to presentation ranged from 1 day to 1 year (median: 6.5 days). Diagnostic modalities evolved over time: fluoroscopic angiography was predominant pre -2000s, while CT angiography became standard thereafter. Management included:Antithrombotic therapy in 18 cases (3 required decompressive craniotomy)Endovascular intervention in 3 casesOpen surgical repair in 8 casesOne hybrid thrombectomy and endarterectomy There were 4 deaths. Overall, 50% of cases resulted in fatality or disabling stroke. Carotid dissection was identified in 29 cases; vertebral in 1. Horner’s syndrome was noted in at least 3 carotid cases. Conclusions Delayed CAD presentation demands a high index of suspicion. Early imaging and intervention may mitigate catastrophic outcomes in this under -recognised clinical entity.