Evidence map›Paper›PMID 40097874›Full record

SynthesisNeurosurgical review2025

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

Nanthiya Sujijantarat, Bushra Fathima, Varun Padmanaban, Jacob Kosyakovsky, Aladine A Elsamadicy, Joseph O Haynes, Andrew B Koo, Ganesh M Shankar, Robert W Regenhardt, Christopher J Stapleton and 4 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Neurosurgical review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Nanthiya SujijantaratDepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Wang Building, Suite 745, Boston, CT, 02114, USA.
Bushra FathimaDepartment of Neurosurgery, Yale-New Haven Hospital, Yale University, New Haven, CT, USA.
Varun PadmanabanDepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Wang Building, Suite 745, Boston, CT, 02114, USA.
Jacob KosyakovskyDepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Wang Building, Suite 745, Boston, CT, 02114, USA.
Aladine A ElsamadicyDepartment of Neurosurgery, Yale-New Haven Hospital, Yale University, New Haven, CT, USA.
Joseph O HaynesDepartment of Neurosurgery, Yale-New Haven Hospital, Yale University, New Haven, CT, USA.
Andrew B KooDepartment of Neurosurgery, Yale-New Haven Hospital, Yale University, New Haven, CT, USA.
Ganesh M ShankarDepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Wang Building, Suite 745, Boston, CT, 02114, USA.
Robert W RegenhardtDepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Wang Building, Suite 745, Boston, CT, 02114, USA.
Christopher J StapletonDepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Wang Building, Suite 745, Boston, CT, 02114, USA.
James D RabinovDepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Wang Building, Suite 745, Boston, CT, 02114, USA.
Ryan M HebertDepartment of Neurosurgery, Yale-New Haven Hospital, Yale University, New Haven, CT, USA.
Charles C MatoukDepartment of Neurosurgery, Yale-New Haven Hospital, Yale University, New Haven, CT, USA.
Aman B PatelDepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Wang Building, Suite 745, Boston, CT, 02114, USA. abpatel@mgh.harvard.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundVertebral 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.

methodsWe 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.

resultsFifteen 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.

conclusionsA 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.

Indexed as

Arterial Occlusive DiseasesVertebral ArteryVertebrobasilar InsufficiencyCervical VertebraeHumansSpinal Cord InjuriesStrokeBiffl IVCervical injuryDenver IVSpinal cord injuryTraumatic occlusionVAOVertebral injuryVertebral occlusion

Identifiers

PMID40097874

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.