title: Comparison of single versus multiple spontaneous extra- and/or intracranial arterial dissection.
abstract: BACKGROUND
  Anecdotal data suggest that approximately 20% of patients with a spontaneous extra- and/or intracranial arterial dissection have multiple arterial involvement. Limited data exist regarding the clinical and angiographic characteristics of patients with multiple arterial dissections. We compared the clinical and angiographic features of patients with spontaneous multiple extra- and/or intracranial arterial dissections with those who have a single arterial dissection.
  
  
  METHODS
  A retrospective chart review of the consecutive ischemic stroke database over a 7-year period, maintained at 2 institutions, was conducted to identify patients with spontaneous extra- and/or intracranial arterial dissection. The patients' clinical characteristics and angiographic features (including the artery affected, presence of pseudoaneurysm, fibromuscular dysplasia, and degree of stenosis) were analyzed.
  
  
  RESULTS
  A total of 76 patients were admitted with spontaneous extra- and/or intracranial arterial dissection; 46 dissections were confirmed with 4-vessel cerebral angiography. Multiple arterial dissections were found in a total of 10 (22%) patients. Involvement of multiple arteries was more prevalent in the young, when compared to a single spontaneous arterial dissection (7 [70%] in patients <45 years of age v 11 [31%]; P = .03). Patients with multiple arterial dissections had a higher proportion of pseudoaneurysms (9 [90%] v 11 [31%]; P = .001), a higher prevalence of underlying fibromuscular dysplasia (3 [30%] v 3 [8%]; P = .11), and were more likely to involve the posterior circulation (P < .0001).
  
  
  CONCLUSIONS
  The presence of multiple, simultaneous spontaneous extra- and/or intracranial arterial dissections must be considered when a single spontaneous arterial dissection is identified.
authors.affiliation: Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN, USA. ameerehassan@gmail.com
authors.forename: Ameer E
authors.initials: AE
authors.lastname: Hassan
authors.forename: Haralabos
authors.initials: H
authors.lastname: Zacharatos
authors.forename: Yousef M
authors.initials: YM
authors.lastname: Mohammad
authors.forename: Nauman
authors.initials: N
authors.lastname: Tariq
authors.forename: Gabriella
authors.initials: G
authors.lastname: Vazquez
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Rodriguez
authors.forename: M Fareed K
authors.initials: MF
authors.lastname: Suri
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000453:epidemiology; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000453:epidemiology; D015901:Angiography, Digital Subtraction; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D005352:Fibromuscular Dysplasia / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging / Q000453:epidemiology