Abstract WP173: Characteristics and Prognostic Factors for the Imaging Outcomes in Cervicocerebral Artery Dissection

Abstract

Introduction: Although cervicocerebral artery dissection is a common cause of ischemic stroke in young adults, the effectiveness of imaging findings in predicting outcomes is not well established. We aimed to identify the baseline characteristics and imaging outcomes as well as prognostic factors which influence imaging outcomes for cervicocerebral artery dissection. Methods: We included 190 consecutive patients who presented with ischemic symptoms associated with cervicocerebral artery dissection on baseline vascular images. Imaging findings on the baseline were obtained within 7 days after symptom onset, and follow-up vascular images were performed at 3 months, 6 months, or 1 year. We compared the imaging features and the degrees of recovery (complete or partial recovery) between the baseline and follow-up vascular images. Results: A total of 133 patients who underwent vascular imaging at baseline and either 6 months or 1 year were compared for these analyses. The median interval between baseline symptom onset and the first vascular imaging was within 24 hours (IQR 0, 1). Regarding the lesion sites, a dissection was more common in the intracranial arteries (78.2%) than the extracranial (21.8%). The most common site of dissection was the vertebral artery (51.1%) with V4 being the most common (38.3%). Follow-up images showed partial or complete improvement of the dissected vessels in 53% (95% CI, 42-63%) at 6 months and 91% (95% CI, 83-95%) at 1 year. The lesions with stenotic/occlusion revealed better imaging recovery compared with lesions with an aneurysm (67.6% vs. 21.3% at 6 months, p<0.002; 85.7% vs. 27.7% after 1 year, p<0.002). After adjustment for the age, gender, and eGFR, a multivariate analysis proved that dyslipidemia (OR 8; 95% CI, 2.6-24.4; p<0.001) and a lesion site on the vertebral artery (OR 2.6; 95% CI, 1.1-6.1; p=0.026) were independent predictors of poor imaging outcome. Conclusions: In patients who were diagnosed with cervicocerebral artery dissection based on baseline vascular images, the rate of complete or partial improvement was over 50% in the 6-month follow-up images. Dyslipidemia and vertebral artery dissection were poor prognostic factors for the recovery of the vascular lesion after cervicocerebral artery dissection.