Biffl scale for blunt cerebrovascular injury
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The Biffl Criteria illustrates the spectrum of blunt cerebrovascular injury (BCVI) seen on angiography (CTA,(both CTA and DSA). This grading system has prognostic and therapeutic implications.
Classification
-
grade I: mild intimal injury or irregular intima
. -
grade II: dissection with raised intimal flap / intramural haematoma with luminal narrowing >
; 25;25% / intraluminal thrombosis - grade III: pseudoaneurysm
-
grade IV: vessel occlusion
/ thrombosis/thrombosis - grade V: vessel transection.
Clinical Implications
A grade I injury heals regardless of therapy. 70% of dissections or haematomas with luminal stenosis (grade II) progressed whilst on heparin therapy. Only 8% of pseudoaneurysms (grade III) healed with heparin, about 89% resolves after endovascular stenting. Occluded carotid arteries (grade IV) does not recanalize in the early post-injury period. Grade V injuries (transections) are lethal
Treatment and refractory to intervention. prognosis
Stroke risk increased with injury grade. The lower the grade the better the prognosis 1
- grade I: heals regardless of therapy
- grade II: 70% of dissections or haematomes with luminal stenosis progressed while on heparin therapy
- grade III: only % of pseduoaneurysms healed with heparing and ~90% resolved after stenting
- grade IV: occluded carotid arteries did not recanalise in the early post-injury period
- grade V: transections are lethal and refractory to therapy
-<p>The <strong>Biffl Criteria</strong> illustrates the spectrum of <a href="/articles/blunt-cerebrovascular-injury">blunt cerebrovascular injury</a> (BCVI) seen on angiography (CTA, DSA). This grading system has prognostic and therapeutic implications.</p><ul>- +<p>The <strong>Biffl Criteria</strong> illustrates the spectrum of <a href="/articles/blunt-cerebrovascular-injury">blunt cerebrovascular injury</a> (BCVI) seen on angiography (both CTA and DSA). This grading system has prognostic and therapeutic implications.</p><h4>Classification</h4><ul>
-<strong>grade I </strong>: mild intimal injury or irregular intima.</li>- +<strong>grade I</strong>: mild intimal injury or irregular intima</li>
-<strong>grade II </strong>: dissection with raised intimal flap / intramural haematoma with luminal narrowing > 25% / intraluminal thrombosis</li>- +<strong>grade II</strong>: dissection with raised intimal flap / intramural haematoma with luminal narrowing >25% / intraluminal thrombosis</li>
-<strong>grade III </strong>: pseudoaneurysm</li>- +<strong>grade III</strong>: <a title="Pseudoaneurysm" href="/articles/false-aneurysm">pseudoaneurysm</a>
- +</li>
-<strong>grade IV </strong>: vessel occlusion / thrombosis</li>- +<strong>grade IV</strong>: vessel occlusion/thrombosis</li>
-<strong>grade V </strong>: vessel transection.</li>-</ul><h5>Clinical Implications</h5><p>A grade I injury heals regardless of therapy. 70% of dissections or haematomas with luminal stenosis (grade II) progressed whilst on heparin therapy. Only 8% of pseudoaneurysms (grade III) healed with heparin, about 89% resolves after endovascular stenting. Occluded carotid arteries (grade IV) does not recanalize in the early post-injury period. Grade V injuries (transections) are lethal and refractory to intervention. Stroke risk increased with injury grade.</p>- +<strong>grade V</strong>: vessel transection.</li>
- +</ul><h4>Treatment and prognosis</h4><p>Stroke risk increased with injury grade. The lower the grade the better the prognosis 1</p><ul>
- +<li>grade I: heals regardless of therapy</li>
- +<li>grade II: 70% of dissections or haematomes with luminal stenosis progressed while on heparin therapy</li>
- +<li>grade III: only % of pseduoaneurysms healed with heparing and ~90% resolved after stenting</li>
- +<li>grade IV: occluded carotid arteries did not recanalise in the early post-injury period</li>
- +<li>grade V: transections are lethal and refractory to therapy</li>
- +</ul>
Tags changed:
- trauma
- refs
- cases
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