R2-recanalization of spontaneous carotid artery dissection.
OBJECTIVE
We set out to investigate the predictors and time course for recanalization of spontaneous dissection of the cervical internal carotid artery (SICAD).


METHODS
We prospectively included 249 consecutive patients (mean age, 45+/-11 years) with 268 SICAD. Ultrasound examinations were performed at presentation, during the first month, and then at 3, 6, and 12 months, and clinical follow-ups after 3, 6, and 12 months.


RESULTS
Of 268 SICADs, 20 (7.5%) presented with <or=50% stenosis, 31 (11.6%) with 51% to 80% stenosis, 92 (34.3%) with 81% to 99% stenosis, and 125 (46.6%) with an occlusion. Antithrombotic treatment included anticoagulation in 174 (67%) patients, aspirin in 64 (24%) patients, and aspirin followed by anticoagulation or vice versa in 22 (8%) patients. Follow-up ultrasound showed normal findings in 160 (60%), <or=50% stenosis in 27 (10%), 51% to 80% stenosis in 4 (1%), 81% to 99% stenosis in 26 (10%), and occlusion in 51 (19%) vessels. The rate of complete recanalization was 16% at 1 month, 50% at 3 months, and 60% at 6 and 12 months. Initial occlusion of the dissected vessels reduced the odds of recanalization (OR, 4.0; 95% CI, 2.2-7.3; P<0.001), whereas the occurrence of local symptoms and signs only at presentation were independently associated with complete recanalization (OR, 0.4; 95% CI, 0.2-0.8; P=0.048).


CONCLUSIONS
These results suggest that recanalization of SICAD occurs mainly within the first 6 months after the onset of symptoms. Initial occlusion reduces the likelihood of complete recanalization, whereas presentation with local symptoms and signs only increases it.
Nedeltchev
Krassen
K
Department of Neurology, University Hospital, Zürich, Switzerland.
Bickel
Stefan
S
Arnold
Marcel
M
Sarikaya
Hakan
H
Georgiadis
Dimitrios
D
Sturzenegger
Matthias
M
Mattle
Heinrich P
HP
Baumgartner
Ralf W
RW
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D011446:Prospective Studies; D014463:Ultrasonography
D000925:Anticoagulants; D005343:Fibrinolytic Agents