title: Differences and similarities between spontaneous dissections of the internal carotid artery and the vertebral artery.
abstract: OBJECTIVE
  To compare potential risk factors, clinical symptoms, diagnostic delay, and 3-month outcome between spontaneous internal carotid artery dissection (sICAD) and spontaneous vertebral artery dissection (sVAD).
  
  
  METHODS
  We compared patients with sICAD (n=668) and sVAD (n=302) treated in 3 university hospitals.
  
  
  RESULTS
  Patients with sICAD were older (46.3 ± 9.6 versus 42.0 ± 10.2 years; P<0.001), more often men (62.7% versus 53.0%; P=0.004), and presented more frequently with tinnitus (10.9% versus 3.4%; P<0.001) and more severe ischemic strokes (median National Institutes of Health Stroke Scale, 10 ± 7.1 versus 5 ± 5.9; P<0.001). Patients with sVAD had more often bilateral dissections (15.2% versus 7.6%; P<0.001) and were more often smokers (36.0% versus 28.7%; P=0.007). Thunderclap headache (9.2% versus 3.6%; P=0.001) and neck pain were more common (65.8% versus 33.5%; P<0.001) in sVAD. Subarachnoid hemorrhage (6.0% versus 0.6%; P<0.001) and ischemic stroke (69.5% versus 52.2%; P<0.001) were more frequent in sVAD. After multivariate analysis, sex difference lost its significance (P=0.21), and all other variables remained significant. Time to diagnosis was similar in sICAD and sVAD and improved between 2001 and 2012 compared with the previous 10-year period (8.0 ± 10.5 days versus 10.7 ± 13.2 days; P=0.004). In sVAD, favorable outcome 3 months after ischemic stroke (modified Rankin Scale, 0-2: 88.8% versus 58.4%; P<0.001), recurrent transient ischemic attack (4.8% versus 1.1%; P=0.001), and recurrent ischemic stroke (2.8% versus 0.7%; P=0.02) within 3 months were more frequent.
  
  
  CONCLUSIONS
  sICAD and sVAD patients differ in many aspects. Future studies should perform separate analyses of these 2 entities.
authors: Department of Neurology, University Hospital Bern, Freiburgstrasse 10, 3010 Bern, Switzerland.
authors: Michelle
authors: M
authors: von Babo
authors: Gian Marco
authors: GM
authors: De Marchis
authors: Hakan
authors: H
authors: Sarikaya
authors: Christian
authors: C
authors: Stapf
authors: Fréderique
authors: F
authors: Buffon
authors: Urs
authors: U
authors: Fischer
authors: Mirjam R
authors: MR
authors: Heldner
authors: Jan
authors: J
authors: Gralla
authors: Simon
authors: S
authors: Jung
authors: Barbara Goeggel
authors: BG
authors: Simonetti
authors: Heinrich P
authors: HP
authors: Mattle
authors: Ralf W
authors: RW
authors: Baumgartner
authors: Marie-Germaine
authors: MG
authors: Bousser
authors: Marcel
authors: M
authors: Arnold
mesh_terms: D000328:Adult; D000792:Angiography; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging; D020217:Vertebral Artery Dissection / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology
keywords: dissection; outcome; risk factor; stroke