Cervical cerebral artery dissection: a multicenter prospective study (preliminary report)

Bassi, Pietro; Lattuada, P.; Gomitoni, A.

doi:10.1007/s100720300025

Cited by 42 publications

(19 citation statements)

References 4 publications

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“…The other articles analyze mixed cases of spontaneous and traumatic cause without separating the outcomes for the spontaneous and traumatic cases. Therefore, it was not possi- (4) 48 X Bassi et al (22) 49 X Dziewas et al (23) 126 X X Townend et al (24) 2 X Lee and Jensen (25) 1 X X X Chiche et al (26) 10 Sagoh et al (27) 1 X Chaves et al (28) 10 X Pace et al (29) 2 X Mas et al (30) 13 X Lin et al (31) 5 X…”

Section: Resultsmentioning

confidence: 99%

Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence

Donas¹,

Mayer²,

Guber³

et al. 2008

Journal of Vascular and Interventional Radiology

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PURPOSE: To provide evidence for the endovascular repair of patients with extracranial carotid artery dissection. MATERIALS AND METHODS: A comprehensive literature review was performed whereby all studies that reported on the results of endoluminal repair of extracranial carotid artery dissection and provided information about primary technical and clinical success were identified. The Pubmed, Embase, and Medline databases were searched between January 1997 and February 2008 by two independent observers by using combinations of search terms "endovascular repair," "extracranial carotid artery," and "carotid dissection." RESULTS: After studies were selected according to the given criteria, 13 studies were included in our statistical analysis. The number of reported patients was 62, with a total of 63 extracranial carotid artery dissections. The mean patient age was 43.3 years. The mean follow-up period was 15.7 months +/-8.7. Various causes were responsible for the disease, including a blunt neck injury in 28 patients (45%), spontaneous dissection in 21 (37%), and iatrogenic trauma during invasive radiologic procedure in 17.7% patients. The technical success rate was 100% (63 of 63 procedures). The primary and 1-year patency rate of the stents and/or stent-grafts was 100%. The overall major adverse cardiovascular events rate was 11% (seven strokes). The total follow-up mortality rate was 0%. CONCLUSIONS: The current status of the reported cases in the literature regarding the treatment of carotid artery dissection by means of stent placement shows excellent early and 1-year patency rates and a low major adverse cardiovascular event rate. However, further evaluation is necessary to draw robust conclusions.

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Section: Resultsmentioning

confidence: 99%

Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence

Donas¹,

Mayer²,

Guber³

et al. 2008

Journal of Vascular and Interventional Radiology

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“…Existem alguns sintomas que classicamente são atribuídos ao compromentimento arterial local (como cervicalgia e cefaléia) e seu aparecimento pode indicar o momento da dissecção servindo como sintoma de alerta ("warning symptom") [13][14][15][16] . No entanto, cerca de 20% dos pacientes não apresentam sinais ou sintomas de alerta precedendo o evento isquêmico impossibilitando que o tempo entre a dissecção e a isquemia seja estimado 16 .…”

Section: Discussionunclassified

“…Para tanto se utilizam drogas que, através da atividade de anticoagulação ou de antiagregação plaquetária, dificultam a formação de trombos no local da dissecção durante o período de cicatrização e recanalização da artéria lesada, que em média é de 3 a 6 meses 1 . Embora não existam estudos randomizados que comprovem a eficácia da heparina ou sua superioridade sobre qualquer outro tratamento como antiagregação, correção cirúrgica ou tratamento endovascular, ainda assim a anticoagulação é o tratamento classicamente recomendado na literatura, exceto nos casos em que haja HSA associada 1,4,15 . Com relação ao uso de trombolítico nos pacientes com AVCI agudo e dissecção arterial cervical, estudos recentes com pequenas amostras demonstraram que o uso do ativador do plasminogênio tissular recombinante (rt-PA) endovenoso ou da uroquinase intra-arterial local nessa população é seguro não tendo aumentado a incidência de hemorragia intracerebral ou arterial cervical [43][44][45] .…”

Section: Discussionunclassified

Dissecção espontânea cervical carotídea e verbal: estudo de 48 pacientes

Campos

Evaristo

Yamamoto

et al. 2004

Arq. Neuro-Psiquiatr.

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, Milberto Scaff 4 RESUMO -Objetivo: Dada a ausência de estudos de séries brasileiras de pacientes com dissecção arterial cervical espontânea, com o objetivo de descrever os fatores de risco, sintomas precedentes, manifestações clínicas, resultados da investigação, tratamento e evolução. Método: realizamos a análise retrospectiva dos prontuários e laudos radiológicos [angiografia digital(AD), ressonância magnética(RM) e ângio-ressonância(ARM)] dos pacientes com esse diagnóstico atendidos no Serviço de Neurologia do HC/USP entre 1997 e 2003. Resultados: 48 pacientes (24 homens), média de idade 37,9 anos; 26 pacientes com dissecção carotídea (DC) unilateral, 15 com vertebral (DV) unilateral e 7 com multiarterial, todos com déficits neurológicos. Os principais fatores de risco para doença vascular foram hipertensão arterial, tabagismo e dislipidemia. Mais de 80% apresentaram pelo menos um sintoma precedente, na maioria cefaléia têmporo-parietal. Cervicalgia foi referida por 44% dos pacientes com DV e por 3,4% dos com DC. O tempo médio entre o primeiro sintoma e o déficit foi 5,4 dias para as DC e 13,5 para as DV.AD foi o principal método diagnóstico (93%), associado a RM e ARM em 42% dos casos. Em 3 pacientes a RM cervical com supressão de gordura foi isoladamente suficiente. 75% dos pacientes receberam anticoagulação. Dois pacientes fizeram trombólise endovenosa sem complicações. A evolução foi boa, exceto por dois óbitos (DC bilateral). Conclusão: Os resultados são semelhantes aos da literatura, exceto pela baixa freqüência de cervicalgia nos casos de DC e pelo predomínio de cefaléia têmporo-parietal nas dissecções arteriais cervicais. Fatores de risco para doença vascular isquêmica foram frequentes. PALAVRAS-CHAVE: dissecção arterial, artéria carótida interna, artéria vertebral, angiografia, ressonância magnética. Spontaneous cervical carotid and vertebral arteries dissection -Study of 48 patientsABSTRACT -Objective: To report a Brazilian series of spontaneous cervical arterial dissections, risk factors, warning symptoms, clinical manifestations, diagnostic tests, treatment and prognosis. Method: We performed the retrospective analysis of clinical and neuroradiological records (MRI, A-MRI and Angiography) of patients with this diagnosis who were evaluated in a tertiary hospital for the period of 1997-2003. Results: 48 patients (24 men) with median age 37.9 years: 26 patients with unilateral internal carotid dissection (ICAD), 15 with unilateral vertebral artery dissection (VAD) and 7 with multivessel dissections. All patients presented neurological deficits. Hypertension, smoking and dyslipidemia were the main risk factors. More than 80% of patients presented at least one initial symptom, most of them temporoparietal headache. 44% of patients with VAD and only 3.4% of patients with ICAD had neck pain. The median interval between the onset of symptom and the appearance of neurological deficit was 5.4 days for ICAD and 13.5 days for VAD. Five patients with ICAD presented preceding TIA. Angiography was performed in...

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“…Some data suggest that intravenous heparin may be effective for preventing further arterial embolization in the setting of cervical dissections. 291,294,301,302 Heparin and similar agents may also promote or hasten the dissolution of the intramural thrombus found in many patients with dissections, thereby promoting healing of the dissection. 294 The risk of heparin causing hemorrhagic transformation in these patients appears to be low (Ͻ5%).…”

Section: A Arterial Dissectionsmentioning

confidence: 99%

“…Although trauma to the neck and spine is commonly associated with such dissections, at least 50% of patients with dissections and stroke have no clear history of antecedent neck trauma. 291,292 Imaging studies such as MRI and magnetic resonance angiography with fat saturation protocols are now commonly used for the noninvasive detection of such dissections. 293,294 Dissections lead to ischemic strokes through artery-to-artery embolism or by causing significant stenosis and occlusion of the proximal vessel.…”

Section: A Arterial Dissectionsmentioning

confidence: 99%

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack

Sacco¹,

Adams²,

Albers³

et al. 2006

Stroke

1,447

297

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Abstract-The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches for the implementation of guidelines and their use in high-risk populations. (Stroke. 2006;37:577-617.)

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Cervical cerebral artery dissection: a multicenter prospective study (preliminary report)

Cited by 42 publications

References 4 publications

Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence

Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence

Dissecção espontânea cervical carotídea e verbal: estudo de 48 pacientes

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack

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