Cervicocranial arterial dissection

experience of 73 patients in a single center

Yung Chien Huang, Ya Fang Chen, Yao Hung Wang, Yong Kwang Tu, Jiann Shing Jeng, Hon Man Liu

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background: Arterial dissection involving cervicocranial arteries usually results in ischemia or SAH. This study correlated the clinical manifestations, image characteristics, and outcome of arterial dissection and compared the differences between arterial dissection of anterior and posterior circulation at our institute. Methods: Clinical symptoms and neuroradiologic findings were retrospectively analyzed in 73 patients (6-75 years old) who had a spontaneous arterial dissection of cervicocranial vessels verified by angiography or MRI. Twenty-four cases of ACAD and 49 cases of PCAD were included in this study. Results: The leading presentation of arterial dissection of ACAD group was ischemic stroke (79.2%), and that of posterior circulation was SAH (44.9%), followed by ischemic stroke (42.8%). In the ACAD group, the extracranial ICA was more commonly involved (62.5%), with long segmental narrowing the most common angiographic finding. In the PCAD group, the intracranial VA was more commonly involved (81.6%), with alternating narrowing and dilatation the leading angiographic picture. All the cases presenting with ischemic stroke or headache were conservatively treated with anticoagulants or antiplatelets, except for one treated with intra-arterial thrombolysis for thromboembolism in basilar artery at an early stage. One of them died of progressed brainstem infarct in spite of anticoagulation therapy. All the others reached improved or stable clinical condition. Eighteen cases were treated by surgical or endovascular intervention. None of them had rebleeding. Of the 5 patients with SAH due to dissecting lumens without treatment, 2 died of rebleeding. Conclusions: Ischemia is the predominant presentation of ACAD; and PCAD has similar occurrence of SAH and ischemia. Intracranial arterial dissection is not uncommon; and it should be kept in the list of differential diagnosis of young stroke. Aggressive treatment of arterial dissection presenting with SAH should be considered; otherwise, rebleeding may occur.

Original languageEnglish
Pages (from-to)S20-S27
JournalSurgical Neurology
Volume72
Issue numberSUPPL. 2
DOIs
Publication statusPublished - Dec 1 2009
Externally publishedYes

Fingerprint

Dissection
Stroke
Ischemia
Basilar Artery
Magnetic Resonance Angiography
Thromboembolism
Anticoagulants
Brain Stem
Headache
Dilatation
Differential Diagnosis
Therapeutics
Arteries

Keywords

  • Arterial dissection
  • Carotid artery
  • Ischemic stroke
  • Subarachnoid hemorrhage
  • Vertebrobasilar artery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Cervicocranial arterial dissection : experience of 73 patients in a single center. / Huang, Yung Chien; Chen, Ya Fang; Wang, Yao Hung; Tu, Yong Kwang; Jeng, Jiann Shing; Liu, Hon Man.

In: Surgical Neurology, Vol. 72, No. SUPPL. 2, 01.12.2009, p. S20-S27.

Research output: Contribution to journalArticle

Huang, Yung Chien ; Chen, Ya Fang ; Wang, Yao Hung ; Tu, Yong Kwang ; Jeng, Jiann Shing ; Liu, Hon Man. / Cervicocranial arterial dissection : experience of 73 patients in a single center. In: Surgical Neurology. 2009 ; Vol. 72, No. SUPPL. 2. pp. S20-S27.
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abstract = "Background: Arterial dissection involving cervicocranial arteries usually results in ischemia or SAH. This study correlated the clinical manifestations, image characteristics, and outcome of arterial dissection and compared the differences between arterial dissection of anterior and posterior circulation at our institute. Methods: Clinical symptoms and neuroradiologic findings were retrospectively analyzed in 73 patients (6-75 years old) who had a spontaneous arterial dissection of cervicocranial vessels verified by angiography or MRI. Twenty-four cases of ACAD and 49 cases of PCAD were included in this study. Results: The leading presentation of arterial dissection of ACAD group was ischemic stroke (79.2{\%}), and that of posterior circulation was SAH (44.9{\%}), followed by ischemic stroke (42.8{\%}). In the ACAD group, the extracranial ICA was more commonly involved (62.5{\%}), with long segmental narrowing the most common angiographic finding. In the PCAD group, the intracranial VA was more commonly involved (81.6{\%}), with alternating narrowing and dilatation the leading angiographic picture. All the cases presenting with ischemic stroke or headache were conservatively treated with anticoagulants or antiplatelets, except for one treated with intra-arterial thrombolysis for thromboembolism in basilar artery at an early stage. One of them died of progressed brainstem infarct in spite of anticoagulation therapy. All the others reached improved or stable clinical condition. Eighteen cases were treated by surgical or endovascular intervention. None of them had rebleeding. Of the 5 patients with SAH due to dissecting lumens without treatment, 2 died of rebleeding. Conclusions: Ischemia is the predominant presentation of ACAD; and PCAD has similar occurrence of SAH and ischemia. Intracranial arterial dissection is not uncommon; and it should be kept in the list of differential diagnosis of young stroke. Aggressive treatment of arterial dissection presenting with SAH should be considered; otherwise, rebleeding may occur.",
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AU - Liu, Hon Man

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AB - Background: Arterial dissection involving cervicocranial arteries usually results in ischemia or SAH. This study correlated the clinical manifestations, image characteristics, and outcome of arterial dissection and compared the differences between arterial dissection of anterior and posterior circulation at our institute. Methods: Clinical symptoms and neuroradiologic findings were retrospectively analyzed in 73 patients (6-75 years old) who had a spontaneous arterial dissection of cervicocranial vessels verified by angiography or MRI. Twenty-four cases of ACAD and 49 cases of PCAD were included in this study. Results: The leading presentation of arterial dissection of ACAD group was ischemic stroke (79.2%), and that of posterior circulation was SAH (44.9%), followed by ischemic stroke (42.8%). In the ACAD group, the extracranial ICA was more commonly involved (62.5%), with long segmental narrowing the most common angiographic finding. In the PCAD group, the intracranial VA was more commonly involved (81.6%), with alternating narrowing and dilatation the leading angiographic picture. All the cases presenting with ischemic stroke or headache were conservatively treated with anticoagulants or antiplatelets, except for one treated with intra-arterial thrombolysis for thromboembolism in basilar artery at an early stage. One of them died of progressed brainstem infarct in spite of anticoagulation therapy. All the others reached improved or stable clinical condition. Eighteen cases were treated by surgical or endovascular intervention. None of them had rebleeding. Of the 5 patients with SAH due to dissecting lumens without treatment, 2 died of rebleeding. Conclusions: Ischemia is the predominant presentation of ACAD; and PCAD has similar occurrence of SAH and ischemia. Intracranial arterial dissection is not uncommon; and it should be kept in the list of differential diagnosis of young stroke. Aggressive treatment of arterial dissection presenting with SAH should be considered; otherwise, rebleeding may occur.

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KW - Subarachnoid hemorrhage

KW - Vertebrobasilar artery

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