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Table 5: Grade-based treatment, follow-up, and suggested management of BCVI
Injury Grade Initial Treatment Surgical or Endovascular Treatment Follow-Up^{^a} Long-Term Treatment
I Antithrombotic therapy^{^b} (preferably unfractionated heparin) or observation (rarely used) Not needed 7–10 days, then 3–6 mo until healed Antiplatelet therapy until healing
II Antithrombotic therapy^{^b} Needed if neurologic symptoms or progression of dissection 7–10 days, then 3–6 mo (until healed or definitive management) Long-term antiplatelet therapy until healing or definitive interventional or surgical treatment
III Needed if symptomatic or size >1 cm 7–10 days and then 3–6 mo or based on symptoms Long-term antiplatelet therapy until healing or definitive treatment
IV Typically not beneficial Based on symptoms Life-long antiplatelets
V Direct pressure on actively bleeding area Emergent intervention/surgery Based on symptoms No data (symptomatic)
↵a Follow-up for asymptomatic carotid cavernous injury is 3–4 weeks.
↵b Unless contraindicated.