Extracranial and intracranial vertebral artery dissection: long-term clinical and duplex sonographic follow-up.
OBJECTIVE
To determine the value of color Doppler sonography (CDUS) in the diagnosis and follow-up of patients with extracranial and intracranial vertebral artery (VA) dissection.


METHODS
Thirty-three patients aged 42 +/- 12 years with 40 VADS confirmed via digital subtraction angiography (DSA) (n = 37) and magnetic resonance angiography (MRA) (n = 3) were included in the study. All patients were investigated with extracranial CDUS and transcranial CDUS (TCCDUS) over a mean +/- SD follow-up period of 42 +/- 24 months and occurrence of new ischemic symptoms was assessed. Sonographic results were compared with initial and follow-up angiographic results.


RESULTS
At presentation, 24/33 (73%) patients had suffered an ischemic stroke, 5/33 (15%) had a transient ischemic attack (TIA), and 4/33 (12%) were asymptomatic. Two patients had a recurrent vertebrobasilar TIA; there was no recurrent stroke. The initial DSA findings consisted of 14 stenoses, 20 tapered occlusions, and 6 pseudoaneurysms. During follow-up, 63% of the vessels recanalized. Sonographic findings were consistent with angiographic findings in 80% at the initial examination and in 86% during follow-up. The main reason for discordant results was the failure of CDUS to detect pseudoaneurysms. No recurrence occurred in the vertebral arteries (VA), but 1 patient had an asymptomatic carotid artery dissection during follow-up.


CONCLUSIONS
Recurrent TIA or stroke after VAD appears to be extremely rare, independent of recanalization or persistent occlusion of the affected artery. CDUS and TCCDUS provide reliable follow-up of VAD in all patients presenting with stenosis or occlusion, but do not allow for detection of pseudoaneurysms of the VA.
Wessels
Tiemo
T
Department of Neurology, RWTH Aachen University Hospital, Pauwelsstr 30, D-52074 Aachen, Germany.
Mosso
Maria
M
Krings
Timo
T
Klötzsch
Christof
C
Harrer
Judith U
JU
D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D018615:Ultrasonography, Doppler, Color; D020217:Vertebral Artery Dissection / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology