Abstract
BackgroundCervicocerebral artery dissection is an important cause of ischemic stroke in young and middle-aged individuals. However, very few studies have compared the differential features between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD), including both cervical and intracranial artery dissections. We conducted a study to investigate the predisposing factors and radiological features in patients with ICAD or VAD.MethodsAll cases diagnosed with cervicocerebral artery dissection, ICAD, or VAD were identified through a medical records database, between January 2010 and January 2020. Baseline characteristics, predisposing factors, and radiological features of ICAD versus VAD were compared.ResultsA total of 140 patients with cervicocerebral artery dissection were included in the study, including 84 patients in the ICAD group and 56 in the VAD group. The mean age of patients in the ICAD and VAD groups was 43.37 ± 14.01 and 41.00 ± 12.98 years old, respectively. Patients with ICAD were more likely to be men compared with VAD (85.71% vs. 67.86%, p = 0.012). The frequency of hypertension, diabetes, smoking, drinking, and cervical trauma did not differ between ICAD and VAD. Dissections of ICAD were more frequently at the extracranial portions of the artery compared with those of VAD (70.24% vs. 44.64%, p = 0.003). In contrast, dissections of VAD were more common in the intracranial artery (55.36% vs. 29.76%, p = 0.003). Radiologically, double lumen (36.90% vs. 19.64%, p = 0.029) and intimal flap (11.90% vs. 1.79%, p = 0.029) were more frequently observed in ICAD than in VAD, and dissecting aneurysms were less frequent (13.10% vs. 26.79%, p = 0.041).ConclusionsThe distributions of cervical and intracranial artery dissections were different between ICAD and VAD. The frequencies of radiological features detected in patients with ICAD and VAD also differed.
Highlights
Cervicocerebral artery dissection is an important cause of ischemic stroke in young and middle-aged individuals
Both cervical artery dissection and intracranial artery dissection were included in the analysis if patients presented with an intramural hematoma, intimal flap, double lumen, long tapering stenosis, artery occlusion that recanalizes in an irregular aneurysmal dilation or stenosis, or irregular aneurysmal dilation with rapid changes in morphology or associated with focal stenosis on magnetic resonance imaging and angiography (MRI, Magnetic resonance angiography (MRA)), or computed tomography angiography (CTA), or digital subtraction angiography (DSA) [9, 12, 13]
One patient with fibromuscular dysplasia was identified in vertebral artery dissection (VAD), but the incidence of fibromuscular dysplasia did not differ between internal carotid artery dissection (ICAD) and VAD (p = 0.219, Table 1)
Summary
Cervicocerebral artery dissection is an important cause of ischemic stroke in young and middle-aged individuals. Very few studies have compared the differential features between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD), including both cervical and intracranial artery dissections. We conducted a study to investigate the predisposing factors and radiological features in patients with ICAD or VAD. CAD is an important cause of ischemic stroke in young and middle-aged individuals [2, 3]. It has been reported that the annual incidence of spontaneous internal carotid artery dissection (ICAD) is approximately 2.5– 3.0 per 100,000 individuals and that of vertebral artery dissection (VAD) is 1.0–1.5 per 100,000 individuals [1, 4]. Surgical or endovascular treatments may be used in patients with persistent symptoms of ischemia despite optimum medical treatment, or subarachnoid hemorrhage [6,7,8]
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