BCVI Pseudoaneurysm Classification
A pseudoaneurysm is classified as Grade III in the Blunt Cerebrovascular Injury (BCVI) grading system. 1, 2
BCVI Grading System
The established grading system for BCVI, which has both prognostic and therapeutic implications, classifies injuries as follows 1, 2:
- Grade I: Minor intimal irregularity or intimal tear (≤10 mm) 3, 1
- Grade II: Large intimal flap, dissection with hematoma, or thrombus (≥10 mm in length or width); includes dissections with luminal stenosis 3, 1, 2
- Grade III: Pseudoaneurysm 3, 1, 2
- Grade IV: Complete vessel occlusion 1, 2
- Grade V: Vessel transection 1, 2
Clinical Significance of Grade III Injuries
Grade III BCVI (pseudoaneurysms) carry significant stroke risk and require aggressive management:
- Grade III injuries demonstrate a 7% cerebral infarction rate, with most strokes occurring at or shortly after hospital admission 4
- Only 8% of pseudoaneurysms heal spontaneously with heparin therapy alone 1, 2
- Radiographic follow-up at 7-10 days shows that 89% of Grade III injuries persist despite medical management 1, 4
- At final imaging, 53% remain stable, 25% worsen, 11% improve, and 11% resolve 4
Management Considerations
Antiplatelet therapy (aspirin) is the primary recommended treatment for Grade III BCVI 4:
- 75% of Grade III BCVI patients are successfully managed with aspirin alone 4
- Endovascular stenting has been advocated but carries a 21% complication rate and 45% occlusion rate, compared to 5% occlusion with antithrombotic therapy alone 5
- The risks of stent placement (including stroke, dissection, and vessel occlusion) may exceed the benefits in many cases 5
Common pitfall: Assuming all pseudoaneurysms require endovascular intervention—medical management with aspirin remains first-line therapy, with intervention reserved for specific high-risk scenarios 5, 4.