title: Cervicocranial arterial dissection: experience of 73 patients in a single center.
abstract: 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.
authors.affiliation: Department of Radiology, Medical School and Hospital, National Taiwan University, Taipei 10016, Taiwan.
authors.forename: Yung-Chien
authors.initials: YC
authors.lastname: Huang
authors.forename: Ya-Fang
authors.initials: YF
authors.lastname: Chen
authors.forename: Yao-Hung
authors.initials: YH
authors.lastname: Wang
authors.forename: Yong-Kwang
authors.initials: YK
authors.lastname: Tu
authors.forename: Jiann-Shing
authors.initials: JS
authors.lastname: Jeng
authors.forename: Hon-Man
authors.initials: HM
authors.lastname: Liu
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors