Prognosis of spontaneous cervical artery dissection and transcranial Doppler findings associated with clinical outcomes.
OBJECTIVE
We categorised spontaneous cervical artery dissection (sCAD) by radiological features and investigated factors associated with favourable outcomes.


METHODS
We retrospectively analysed 128 patients with sCAD with a median follow-up duration of 25 months. Twenty-nine constituted the aneurysm group, 52 the stenotic group, and 47 the occlusive group. Various relevant factors, including National Institute of Health Stroke Scale (NIHSS) scores, type of antithrombotic therapy, stroke progression in the first week, and transcranial Doppler (TCD) flow-waveforms (in the occlusive subgroup) were analysed. Favourable outcomes were defined as a 1-year modified Rankin-Scale score of 0-1. Favourable anatomical outcomes were defined as a reversal of dissection-associated stenosis during follow-up.


RESULTS
The aneurysm and stenotic groups showed favourable outcomes, while the occlusive group outcomes were less favourable. In the stenotic group, anticoagulation, an NIHSS score ≥4, and stroke progression were inversely associated with favourable long-term outcomes. Remarkably, in the occlusive group, flow abnormality more severe than minimal flow was associated with stroke progression, unfavourable long-term outcome, and arterial irreversibility.


CONCLUSIONS
The outcome of sCAD depends on its radiological subtype. In the occlusive subtype, which is associated with the worst outcome, TCD flow analysis may predict acute stroke progression and long-term outcome.


CONCLUSIONS
• Outcomes in cervical artery dissection may be determined by radiological subtypes. • The aneurysm and stenotic groups had favourable outcomes. • The occlusive group had less favourable functional outcomes. • Flow-waveform analysis by TCD could predict functional and anatomical outcomes.
Department of Neurology, Seoul National University Hospital, Seoul, South Korea.
Woo-Jin
WJ
Lee
Department of Neurology, Seoul National University Hospital, Seoul, South Korea. jungkh@gmail.com.|Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea. jungkh@gmail.com.
Keun-Hwa
KH
Jung
Department of Neurology, Seoul National University Hospital, Seoul, South Korea.
Jangsup
J
Moon
Department of Neurology, Seoul National University Hospital, Seoul, South Korea.|Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea.
Soon-Tae
ST
Lee
Department of Neurology, Seoul National University Hospital, Seoul, South Korea.|Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea.
Kon
K
Chu
Department of Neurology, Seoul National University Hospital, Seoul, South Korea.|Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea.
Sang-Kun
SK
Lee
Department of Neurology, Seoul National University Hospital, Seoul, South Korea.|Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea.
Jae-Kyu
JK
Roh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*; D020217:Vertebral Artery Dissection / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology
Dissection; Internal carotid artery; Prognosis; Transcranial Doppler Sonography; Vertebral artery