What is your approach to management and surveillance in low grade traumatic blunt ICA injury?

For blunt cerebrovascular injury (BCVI), I use the Biffl scale to evaluate the extent of vessel trauma. The extracranial neck vessels, such as the cervical ICA or VA, are most commonly affected. The Biffl classification consists of five categories, with Grade 1 representing a low-grade injury. This is defined as 'minimal luminal irregularity or intramural hematoma/dissection with less than 25% luminal narrowing,' essentially a low-grade dissection.

In these cases, I typically initiate aspirin monotherapy after clearance from the Trauma team. Once the patient is stabilized from a trauma perspective, I consider adding clopidogrel if certain factors, such as the location or size of the injury, or underlying vessel pathology (e.g. diseased or t...