Traumatic vertebral artery occlusion is associated with high rates of recanalization: insights from a systematic review and meta-analysis.

Abstract

Background: Vertebral artery occlusion (VAO) is a known complication of blunt cervical injuries and can be associated with a risk of devastating strokes. VAO can spontaneously recanalize, particularly following cervical spine intervention. The aim of this study is to examine overall recanalization rates, recanalization in the context of cervical spine intervention, and the associations between VAO and stroke, spinal cord injury, and acute cervical deformity.

Methods: We conducted a systematic review and meta-analysis of literature using Medline, EMBASE, Cochrane, and manual citation searches. Included studies reported at least 5 adult patients with traumatic VAO and delayed radiographic outcomes, unless embolization was performed for permanent occlusion during the initial admission. Cervical spine intervention was defined as open surgery or external traction. Random effects meta-analysis was used.

Results: Fifteen of 755 studies were included. VAO was associated with spinal cord injury in 67% of cases (95%CI, 43-92%, n = 132, p < 0.001) and acute cervical deformity in 73% (95%CI, 62-83%, n = 91, p < 0.001). The incidence of stroke at presentation was 13% (95%CI, 6-19%, n = 269, p < 0.001). The overall rate of VAO recanalization was 36% in non-embolized patients (95%CI, 23-48%, n = 285, p < 0.001). When only studies reporting on cervical spine intervention were considered, the rate of recanalization post-intervention was 57% (95%CI, 30-85%, n = 45, p < 0.001). Follow-up periods were highly variable, ranging from 1 to 103 weeks.

Conclusions: A substantial portion of traumatic VAOs recanalized at follow-up, with more than half of patients undergoing cervical spine intervention recanalizing. The analyses revealed considerable heterogeneity, likely indicative of variability in clinical practices, established guidelines and reporting standards. These findings offer important insights into the natural history of traumatic VAO and should be considered when choosing management strategies for this patient population.