Cervicocranial arterial dissection: experience of 73 patients in a single center.
BACKGROUND
Arterial dissection involving cervicocranial arteries usually results in ischemia or SAH. This study correlated the clinical manifestations, image characteristics, and outcome of arterial dissection and compared the differences between arterial dissection of anterior and posterior circulation at our institute.


METHODS
Clinical symptoms and neuroradiologic findings were retrospectively analyzed in 73 patients (6-75 years old) who had a spontaneous arterial dissection of cervicocranial vessels verified by angiography or MRI. Twenty-four cases of ACAD and 49 cases of PCAD were included in this study.


RESULTS
The leading presentation of arterial dissection of ACAD group was ischemic stroke (79.2%), and that of posterior circulation was SAH (44.9%), followed by ischemic stroke (42.8%). In the ACAD group, the extracranial ICA was more commonly involved (62.5%), with long segmental narrowing the most common angiographic finding. In the PCAD group, the intracranial VA was more commonly involved (81.6%), with alternating narrowing and dilatation the leading angiographic picture. All the cases presenting with ischemic stroke or headache were conservatively treated with anticoagulants or antiplatelets, except for one treated with intra-arterial thrombolysis for thromboembolism in basilar artery at an early stage. One of them died of progressed brainstem infarct in spite of anticoagulation therapy. All the others reached improved or stable clinical condition. Eighteen cases were treated by surgical or endovascular intervention. None of them had rebleeding. Of the 5 patients with SAH due to dissecting lumens without treatment, 2 died of rebleeding.


CONCLUSIONS
Ischemia is the predominant presentation of ACAD; and PCAD has similar occurrence of SAH and ischemia. Intracranial arterial dissection is not uncommon; and it should be kept in the list of differential diagnosis of young stroke. Aggressive treatment of arterial dissection presenting with SAH should be considered; otherwise, rebleeding may occur.
Huang
Yung-Chien
YC
Department of Radiology, Medical School and Hospital, National Taiwan University, Taipei 10016, Taiwan.
Chen
Ya-Fang
YF
Wang
Yao-Hung
YH
Tu
Yong-Kwang
YK
Jeng
Jiann-Shing
JS
Liu
Hon-Man
HM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D020520:Brain Infarction / Q000453:epidemiology* / Q000503:physiopathology; D002545:Brain Ischemia / Q000453:epidemiology* / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D020215:Carotid Artery, Internal, Dissection / Q000453:epidemiology* / Q000503:physiopathology; D002533:Cerebral Angiography; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology* / Q000503:physiopathology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D020217:Vertebral Artery Dissection / Q000453:epidemiology* / Q000503:physiopathology; D014715:Vertebrobasilar Insufficiency / Q000453:epidemiology / Q000503:physiopathology; D055815:Young Adult
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors