A case of vertebral artery injury caused by a stab wound to the neck who was long time transported by an ambulance

Abstract

A We present the case of a patient who sustained a vertebral artery injury due to a stab wound to the neck. The 76-year-old male injured himself with a rake at a slippery sea-shore location. He was transferred to the nearest hospital in the late afternoon, and a left vertebral artery injury was suspected on plain and contrast-enhanced CT. After sunset on the same day, he was transferred to our institution for endovascular treatment. Because available time of emergency helicopter service in Japan is limited to daylight hours, he was transferred by ambulance, which took nearly 2.5h. During the transfer medical staff held his head to prevent additional injuries due to unexpected rolling or bouncing in the ambulance. Fortunately no harmful event occurred, and he was successfully treated. Although endovascular treatment is available at a limited number of institutions, patients with a suspected vertebral artery injury should be transferred to such an institution. If the transfer distance is long, examinations for the injury should be minimized and transfer by helicopter should be considered as early as possible. If a helicopter is not available, care should be taken to minimize the stress experienced by the patient and medical staff during the transfer.