Abstract TP92: Dynamic Digital Subtraction Angiography With Rotation of Head and Neck May Serve as Critical Imaging Modality and Temporary Use of Cervical Collar in Addition to Anti-Platelet Therapy May Prevent Stroke in Cases of Acute Cervical Vertebral Artery Dissection (CVAD)

Abstract

Introduction: The AHA/ASA have published a statement on the CVAD in 2014 in which a variety of imaging modalities that are performed with the head in neutral position are discussed and pharmacological and endovascular treatment of CVAD is reviewed. The authors have performed a prospective study of 12 patients with acute spontaneous CVAD from 2012 to 2019 who developed angiographic worsening stenosis or occlusion of the dissected VA associated with rotation of the head and cervical collar was added to the anti-platelet therapy. Methods: From 2012 to 2019, we performed a prospective study of 12 consecutive patients with spontaneous acute CVAD. We reviewed initial and follow-up clinical data and dynamic catheter cerebral angiogram with the patient’s head and neck in the straight neutral position and the head turned to the right and left beyond 60 degrees. Results: A total of 12 patients (Age 41.8 +/- 9.8; M=8, F=4) presented with acute stroke or TIA due to a total of 12 CVAD at the level of V1 (N=1), V2 (N=2), V3 (N=5), V4 (N= 2), V2-3 (N=2) segments diagnosed by cerebral angiogram. Initial mRS and NIHSS scores on admission were 3 +/-0.5 and 1.5 +/- 1.9, respectively. Dynamic cerebral angiogram performed with the patient’s head in neutral position showed average stenosis of 71.6 % +/- 18.9. Symptomatic occlusion or worsening stenosis of the dissected VA was observed on dynamic cerebral angiogram with rotation of the head to the contra-lateral side in 10 of 12 patients (83%). All patients were treated with daily Aspirin and Plavix for at least 3 months and placed on a cervical collar for 1 month. A follow-up dynamic cerebral angiogram at 1.8 +/- 1.4 months showed resolution of rotational occlusion or worsening stenosis of the VA. Clinical follow-up evaluation at 13.1+/- 10.9 months showed mRS score of 0.9+/- 1.0 and NIHSS score of 0.4 +/- 0.7 with no recurrent stroke. Conclusion: Dynamic cerebral angiogram may be critical in diagnosing rotational occlusion or stenosis of the dissected VA in patients with acute CVAD. Traditional imaging of the head and neck in neutral position may fail to diagnose adverse effect of rotation of the head and neck in these patients. Temporary use of cervical collar to prevent rotation of the head in the acute period of CVAD should be considered.