title: Cervicocranial arterial dissection: an analysis of the clinical features, prognosis, and treatment efficacy.
abstract: Clinical features and therapeutic strategies of cervicocranial arterial dissection (CCAD) are still unclear. A retrospective review was conducted on 71 CCAD patients. Diagnosed by DSA and outcome evaluation was through mRS scores follow-up 12 months. All patients were allocated into three groups according to clinical situation: 1) subarachnoid hemorrhage (SAH), 2) ischemic symptoms and 3) mass effect. CCAD with anterior circulation arterial dissection (ACAD) had higher ischemia than that with posterior circulation arterial dissection (PCAD) (p=0.023). The non-aneurysmal dissection (NAD) patients were susceptible to ischemia (p=0.00) and patients with aneurismal dissection (AD) were more susceptible to SAH (p=0.001); The outcome of patients with SAH was significantly worse than patients with other manifestations (p=0.012). Following up one year, the outcome of CCAD involving posterior inferior cerebellar artery (PICA) was significantly worse than the other area (p=0.035). There was no statistically significant difference in mRS scores between endovascular treatment and conservative treatment (p=0.052) at one year follow-up. Patients suffering from SAH that received endovascular treatment experienced improved outcomes than patients with conservative treatment (p=0.033). The patients in the ACAD, NAD and extracranial CCAD groups were more likely to suffer from ischemia, while patients in the AD group were susceptible to SAH. CCAD with SAH or involving PICA had poor prognoses. The therapeutic efficacy of conservative treatment is nearly equal to endovascular treatment in CCAD patients follow up 12 months; however, endovascular treatment may decrease the risk of mortality for the patient with SAH.
authors.affiliation: Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 ZhongShan Road, Nanjing City, Jiangsu Province, 210008, PR China.
authors.forename: Jiali
authors.initials: J
authors.lastname: Jin
authors.forename: Jingjing
authors.initials: J
authors.lastname: Guan
authors.forename: Lai
authors.initials: L
authors.lastname: Qian
authors.forename: Mei-Juan
authors.initials: MJ
authors.lastname: Zhang
authors.forename: Yujie
authors.initials: Y
authors.lastname: Huang
authors.forename: Yongbo
authors.initials: Y
authors.lastname: Yang
authors.forename: Dening
authors.initials: D
authors.lastname: Guan
authors.forename: Hui
authors.initials: H
authors.lastname: Zhao
authors.forename: Yongjuan
authors.initials: Y
authors.lastname: Lin
authors.forename: Zhibin
authors.initials: Z
authors.lastname: Chen
authors.forename: Weiyun
authors.initials: W
authors.lastname: Zhang
authors.forename: Jingwei
authors.initials: J
authors.lastname: Li
authors.forename: Yun
authors.initials: Y
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000784:Aortic Dissection / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D015901:Angiography, Digital Subtraction; D005260:Female; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult