Patterns of blunt cerebrovascular injuries and their endovascular management: A retrospective exploration of clinical characteristics and early outcomes

Objective: To identify the clinico-radiological characteristics and neurological outcomes of patients with blunt cerebrovascular injuries (BCVIs) of the carotid and vertebral arteries managed with endovascular treatment. Methodology: This retrospective observational cohort study conducted at the Department of Neuro Endovascular Surgery at Punjab Institute of Neurosciences Lahore, Pakistan, involving patients who presented with blunt cerebrovascular injuries from January 2023 to December 2025. Descriptive analyses were performed to present the baseline data. We used the chi-square test to assess associations between categorical variables. Results: A total of 34 patients with BCVIs were included in our cohort, with the majority of patients belonging to the adult age group, 67.64% (23). The mean age was 30.56±14.83 years, with male predominance of 61.80% (21). The most common presenting features were headache in 52.94% (18) and proptosis in 41.17% (14) patients. Carotid cavernous fistulae (CCF) were overall the most common pathological lesion (76.47%, 26), among which 64.70% (22) had CCF alone, while 11.76% (4) had CCF with concomitant pseudoaneurysm. Among all the CCFs, type A (direct) were present in 84.61% (22/26) cases. Direct CCF also had a higher complete obliteration rate than indirect fistulas (77.27% vs 25.0%); however, this did not reach statistical significance (p=0.169). On digital subtraction angiography (DSA), lesions were seen to rupture in 91.17% (31). Stand-alone stenting was the most commonly employed endovascular intervention, 47.05% (16), followed by coiling, 20.58% (7). Symptom resolution was observed in 73.52% (25), whereas complete angiographic obliteration was seen in 67.64% (23) patients, with post-procedure complications seen in 5.88% (2) cases. Conclusion: BCVIs were frequently seen in young adults. CCF was the most common pathological lesion. Stenting was the most frequently employed endovascular intervention. Overall, the endovascular management resulted in satisfactory angiographic obliteration and symptom resolution.