Comparison of spontaneous intracranial vertebral artery dissection with large artery disease.
OBJECTIVE
To compare clinical and angiographic characteristics and stroke patterns between spontaneous intracranial vertebral artery dissection (VAD) and vertebral large artery disease (LAD) (atherosclerosis).


METHODS
Retrospective study.


METHODS
Tertiary referral center for cerebrovascular diseases. Patients Twenty-two patients with spontaneous VAD and 25 with LAD in the intracranial portion of the vertebral artery.


METHODS
We compared (1) clinical characteristics, including epidemiologic data, vascular risk factors including inflammatory markers, the presence of headache, and stroke syndromes and severity; (2) stroke pattern on diffusion-weighted imaging, which was classified as vertebral perforator infarct, basilar perforator infarct, small scattered infarct, large scattered infarct, and territorial infarct; and (3) angiographic findings, ie, the distribution of involved arteries, degree of stenosis, and the involvement on the anterior circulation and calcification of vertebral artery.


RESULTS
Although patients with VAD were younger, and more often had headaches and fewer vascular risk factors than those with LAD (P<.01 in all cases), these clinical features were also observed in some LAD patients. Diffusion-weighted imaging data showed that vertebral perforator infarct and small scattered infarct were most common in the VAD group, while territorial infarct and large scattered infarct were most common in the LAD group (P = .02). On angiography, LAD more frequently had anterior circulation arterial involvement (P = .002), higher degree of stenosis (P = .002), and calcifications (P = .008).


CONCLUSIONS
Our findings indicate that results of diffusion-weighted imaging and noninvasive vascular studies might provide clues to the clinical characteristics in differential diagnosis between VAD and LAD.
Lee
Jin Soo
JS
Departments of Neurology, Neurosurgery, and Neuroradiology, Ajou University School of Medicine, Suwon, South Korea.
Yong
Seok Woo
SW
Bang
Oh Young
OY
Shin
Yong Sam
YS
Kim
Byung Moon
BM
Kim
Sun Yong
SY
D000368:Aged; D050197:Atherosclerosis / Q000473:pathology; D002533:Cerebral Angiography; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D014057:Tomography, X-Ray Computed; D020217:Vertebral Artery Dissection / Q000150:complications / Q000453:epidemiology* / Q000473:pathology*; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000453:epidemiology* / Q000473:pathology*