title: Early activation of intracranial collateral vessels influences the outcome of spontaneous internal carotid artery dissection.
abstract: OBJECTIVE
  the effectiveness of different treatments for internal carotid artery (ICA) dissection has not been well defined. Lack of early prognostic indicators may represent a major problem in adequately identifying the most appropriate option for treatment. This study aimed at evaluating the influence of patients' vascular risk profiles and of early cerebral hemodynamic changes in determining the clinical evolution after ICA dissection.
  
  
  METHODS
  sixty-six stroke patients with ICA occlusion due to spontaneous artery dissection were included. Transcranial Doppler was performed within 24 hours from symptom onset to examine cerebral arteries and the patency of the 3 major intracranial collateral vessels (ophthalmic artery and anterior and posterior communicating arteries). Possible recanalization of the occluded ICA within the first month was evaluated. Stroke severity at onset was assessed with the National Institutes of Health Stroke Scale, whereas outcome was defined according to the modified Rankin Scale score at 90 days after stroke onset.
  
  
  RESULTS
  forty patients had at least 2 activated intracranial collateral vessels. The remaining 26 patients, with none or only 1 collateral vessel, showed a significant increased risk of poor recovery (modified Rankin Scale score ≥ 2; adjusted relative risk=14.9; 95% CI, 3.24 to 68.46). Poor recovery was not associated with the occurrence of recanalization, with stroke severity at onset, or with vascular risk profile.
  
  
  CONCLUSIONS
  early assessment of cerebral hemodynamic status and, in particular, the activation of intracranial collateral vessels, may help in predicting the outcome of stroke patients with ICA lumen occlusion as a result of spontaneous dissection.
authors.affiliation: Department of Neuroscience, Marche Polytechnic University, Ancona, Italy. m.silvestrini@univpm.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Silvestrini
authors.forename: Claudia
authors.initials: C
authors.lastname: Altamura
authors.forename: Raffaella
authors.initials: R
authors.lastname: Cerqua
authors.forename: Claudio
authors.initials: C
authors.lastname: Pedone
authors.forename: Clotilde
authors.initials: C
authors.lastname: Balucani
authors.forename: Simona
authors.initials: S
authors.lastname: Luzzi
authors.forename: Marco
authors.initials: M
authors.lastname: Bartolini
authors.forename: Leandro
authors.initials: L
authors.lastname: Provinciali
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Vernieri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020215:Carotid Artery, Internal, Dissection / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D002536:Cerebral Arteries / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D013997:Time Factors