Hemodynamic monitoring via arterial catheterization is considered standard care in severe traumatic brain injury (TBI), yet it harbors potentially catastrophic complications that are particularly devastating in neurosurgical patients. Recent data from Indian trauma centers reveal thrombosis rates of 12 to 15% following arterial cannulation—significantly higher than the 3 to 5% reported in Western cohorts. This disparity stems from multiple factors: delayed recognition in sedated patients, limited access to emergency vascular interventions, and the unique hypercoagulable state induced by TBI.

The intersection of three pathological processes creates perfect conditions for thrombosis: (1) TBI-induced systemic hypercoagulability mediated by brain-derived extracellular vesicles, (2) direct vascular injury from catheter placement, and (3) vasopressor-induced vasoconstriction. Despite this clear pathophysiology, current Brain Trauma Foundation guidelines provide no specific recommendations for thrombosis prevention in this vulnerable population.

This case series highlights the catastrophic potential of intra-arterial thrombosis in neurotrauma patients through three representative cases, analyzes modifiable risk factors, and proposes a practical management algorithm tailored for resource-limited settings.

Article published online:
08 December 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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