ABSTRACT NUMBER: ESOC2026LB132 STROKE PREVENTION IN TRAUMATIC VERTEBRAL ARTERY INJURIES: ENDOVASCULAR STRATEGIES OVER FOUR YEARS OF WAR IN UKRAINE

Abstract Background and aims Traumatic vertebral artery injuries are an underrecognized cause of ischemic stroke in modern warfare. The war in Ukraine provides a unique cohort to evaluate injury patterns and endovascular strategies for stroke prevention. Methods This prospective single-center study included 104 patients with combat-related vertebral artery injuries treated between February 2022 and February 2026. All patients underwent CT and digital subtraction angiography. Injury characteristics were classified using the Biffl scale. Endovascular treatment and 30-day clinical outcomes were assessed. Results Among the 104 patients, 97 (93.3%) sustained VA injuries due to blast-related and shrapnel trauma, while 7 (6.7%) had gunshot wounds. The left VA was injured in 47 (45.2%) patients and the right - in 57 (54.8%). Injury distribution by VA segment was as follows: V1 in 31 (29.8%) cases, V2-54 (51.9%), V3-18 (17.3%), and V4 in 1 (1%). According to the Biffl classification, 16 (15.4%) patients had grade I injuries, 7 (6.7%)-II, 20 (19.2%)-III, 61 (58.7%) grade IV injuries. Endovascular interventions were performed in 75 (72.1%) patients. These included embolization of the injured VA in 51 (49%) cases, embolization of dissecting aneurysms or arteriovenous fistulas - 8 (7.7%), implantation of covered stents at the site of VA injury - 12 (11.5%), and thrombectomy of a dissected VA in 4 (3.8%) cases. Overall mortality during the observation period was 5.8%. Conclusions Traumatic vertebral artery injuries are more frequent in modern warfare. Endovascular treatment is an effective strategy for stroke prevention, with technique selection individualized according to injury location, severity, trauma, and collateral circulation. Conflict of interest