Table 5:

Grade-based treatment, follow-up, and suggested management of BCVI

Injury GradeInitial TreatmentSurgical or Endovascular TreatmentFollow-UpaLong-Term Treatment
IAntithrombotic therapyb (preferably unfractionated heparin) or observation (rarely used)Not needed7–10 days, then 3–6 mo until healedAntiplatelet therapy until healing
IIAntithrombotic therapybNeeded if neurologic symptoms or progression of dissection7–10 days, then 3–6 mo (until healed or definitive management)Long-term antiplatelet therapy until healing or definitive interventional or surgical treatment
IIINeeded if symptomatic or size >1 cm7–10 days and then 3–6 mo or based on symptomsLong-term antiplatelet therapy until healing or definitive treatment
IVTypically not beneficialBased on symptomsLife-long antiplatelets
VDirect pressure on actively bleeding areaEmergent intervention/surgeryBased on symptomsNo data (symptomatic)

  • ↵a Follow-up for asymptomatic carotid cavernous injury is 3–4 weeks.

  • ↵b Unless contraindicated.