Natural History of Cerebrovascular Flow in Cervical Arterial Dissection Using Quantitative Magnetic Resonance Angiography

Abstract

The degree to which cervical arterial dissection (CAD) limits cerebral blood flow and the change in flow over time is not well characterized. This study is the first to evaluate blood flow using quantitative magnetic resonance angiography (QMRA) in this patient population. A retrospective chart review was completed in patients CAD between 2009 and 2019. Inclusion criteria were adults with dissection of internal carotid artery or vertebral artery, who underwent QMRA. Cases were reviewed for presentation, management, and imaging findings. Patients treated endovascularly were excluded. Flow index was calculated using ipsilateral vessel flow divided by contralateral flow. A total of 36 patients were included, mean age 44.8 +/- 11.1 years. 21 patients (51.2%) had internal carotid artery (ICA) dissections, 19 (46.3%) with vertebral artery (VA) dissections, and 1 with both. 6 patients (14.6%) had bilateral or multiple vessels involved. Although flow tended to improve over time in the affected vessel, patients with the lowest flow index on presentation continued to have low flow at follow-up (p<0.001). In addition, cerebral blood flow was shown to be associated with the degree of vessel narrowing, particularly in the ICA (p<0.001, R=0.891, R 2 =0.794), although this effect was not significant in the VA (p=0.237). This study represents the first to assess vessel flow in CAD using QMRA and to describe its patterns over time. Flow tended to improve in all patients over time in the dissected vessel, although patients with low flow on presentation continued to have low flow at follow-up.