Abstract
Objectives
The prognosis of a cerebral artery dissection is known to be benign, but the structural
changes of vessel wall at follow-up are not well known. The natural course of an intracranial
and extracranial artery dissection may differ due to structural differences. We aimed
to figure out how stenosis and other wall features change, according to the dissection
location.
Materials and Methods
We retrospectively enrolled patients who suffered an ischemic stroke or transient
ischemic attack due to a dissection and who had undergone both initial and follow-up
high-resolution magnetic resonance imaging (HRMRI). Patients were dichotomized to
intracranial or extracranial dissection group. The clinical and HRMRI characteristics
of two groups were compared. Factors associated with stenosis changes were also investigated.
Results
A total of 57 patients (intracranial, n = 43; and extracranial, n = 14) were enrolled. The mean age (45.6 vs. 32.2, p < 0.001) was higher and hypertension (37.2% vs. 7.1%, p = 0.04) was more frequent in the intracranial dissection group. In HRMRI analysis,
stenosis improvement (27.9% vs. 85.7%, p < 0.001) were more frequent whereas residual wall enhancement (86.0% vs. 46.2%, p = 0.006) and intramural hematoma (62.8% vs. 21.4%, p = 0.007) were less frequent in the extracranial dissection group. Multivariate analysis
indicated that extracranial location was the only independent factor (odds ratio 8.98,
95 % confidence interval 1.45-55.65; p = 0.02) associated with stenosis improvement.
Conclusions
Younger age, stenosis improvement, disappearance of wall enhancement and intramural
hematoma were more frequent in an extracranial dissection compared with an intracranial
dissection. An extracranial location is independently associated with stenosis improvement
in dissection patients.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cervical artery dissection: a review of the epidemiology, pathophysiology, treatment, and outcome.Arch Neurosci. 2015; 2: e26670
- Epidemiology of cervical artery dissection.Handbook on Cerebral Artery Dissection. Vol 20. Karger, Basel2005: 12-15
- Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study.Neurology. 2003; 61: 1347-1351
- Outcomes after ischemic stroke caused by intracranial atherosclerosis vs dissection.Neurology. 2018; 91: e1751-e1759
- Prognosis of cervical artery dissection.Handbook on Cerebral Artery Dissection. Vol 20. Karger, Basel2005: 129-139
- Antiplatelet therapy vs anticoagulation therapy in cervical artery dissection: the cervical artery dissection in stroke study (CADISS) randomized clinical trial final results.JAMA Neurol. 2019; 76: 657-664
- Recanalization of spontaneous carotid artery dissection.Stroke. 2009; 40: 499-504
- Recanalization of cervical artery dissection: influencing factors and role in neurological outcome.Cerebrovasc Dis. 2004; 17: 93-97
- Vessel wall imaging of the intracranial and cervical carotid arteries.J Stroke. 2015; 17: 238-255
- Spontaneous and unruptured chronic intracranial artery dissection: high-resolution magnetic resonance imaging findings.Clin Neuroradiol. 2018; 28: 171-181
- Clinical and radiographic natural history of cervical artery dissections.J Stroke Cerebrovasc Dis. 2009; 18: 416-423
- Adult cervicocerebral artery dissection: a single-center study of 301 Finnish patients.Eur J Neurol. 2009; 16: 656-661
- Extracranial carotid and vertebral artery dissection: a review.Can J Neurol Sci. 2008; 35: 146-152
- Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection.Lancet Neurol. 2015; 14: 640-654
- Intracranial artery dissection.Eur J Neurol. 2014; 21: 820-826
- Symptomatic recurrence of intracranial arterial dissections: follow-up study of 143 consecutive cases and pathological investigation.Stroke. 2013; 44: 126-131
- Structure and function of vasa vasorum.Trends Cardiovasc Med. 1996; 6: 53-57
- The outer arterial wall layers are primarily affected in spontaneous cervical artery dissection.Neurology. 2011; 76: 1463-1471
Article info
Publication history
Published online: January 14, 2022
Accepted:
December 26,
2021
Received in revised form:
December 20,
2021
Received:
October 4,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106302
Copyright
© 2022 Elsevier Inc. All rights reserved.
