Clinical Manifestation and Radiologic Patterns of Spontaneous Cervicocephalic Dissection According to the Anatomic Location: A Single-Center Analysis in Korean Patients

Abstract

Purpose: Spontaneous cervicocephalic dissection (SCAD) is an important cause of stroke and shows various lesion locations and clinical features. The purpose of this study was to analyze the location of SCAD and its clinical and radiologic patterns in Korean patients.Materials and Methods: Patients with SCAD who were evaluated between 2013 and 2018 at a tertiary center in Korea were reviewed. We classified and compared the morphological (aneurysm or steno-occlusion) and presenting (hemorrhage or infarction) patterns according to the lesion locations (anterior circulation [AC] <i>vs.</i> posterior circulation [PC]; intradural [ID] <i>vs.</i> extradural [ED]).Results: A total of 166 patients were included in this study. The SCAD most commonly occurred in the PC-ID location (65.1%), followed by AC-ID (13.3%), AC-ED (13.3%), and PC-ED (8.4%). Aneurysm and steno-occlusion patterns were observed in 66.9% and 57.8% of the cases, respectively. The aneurysm pattern was significantly more common in the PC-ID location (78.7%) than in other locations. As for the presenting pattern, cerebral infarction was the most common pattern (39.8%), and intracranial hemorrhage was observed only in the ID location (7.2%).Conclusion: In Korean patients, PC-ID, especially ID vertebral artery, was the most common location of SCAD, and most cases were accompanied by an aneurysm. It also suggested that these location trends differ by population or ethnicity.

Flow Diverter Treatment Using a Flow Re-Direction Endoluminal Device for Unruptured Intracranial Vertebral Artery Dissecting Aneurysm: Single-Center Case Series and Technical Considerations

“…The rate of intracranial artery involvement from dissection is exceptionally high in Asia [ 3 - 5 ]. As compared to patients in Western countries, intracranial arterial dissections in Koreans occur most commonly in the posterior circulation, particularly in the vertebral artery (VA) [ 1 , 6 ]. Therefore, there seems to be an ethnic or genetic disposition in the development of VA dissection [ 7 , 8 ].…”

“…The VA, especially the intradural VA, is the most common location of spontaneous cervicocephalic dissection. Most cases are accompanied by an aneurysm and may lead to subsequent subarachnoid hemorrhage [ 6 , 9 , 10 ].…”

“…[3][4][5] As compared to patients in Western countries, intracranial arterial dissections in Koreans occur most commonly in the posterior circulation, particularly in the vertebral artery (VA). 1,6 Therefore, there seems to be an ethnic or genetic disposition in the development of VA dissection. 7,8 Spontaneous cervicocephalic dissection is an important cause of stroke and presents with varying lesion locations and clinical features.…”

“…Most cases are accompanied by an aneurysm and may lead to subsequent subarachnoid hemorrhage. 6,9,10 There are various treatment options for VA dissecting aneurysms (VADAs). 11 If the parent artery has sufficient collaterals and can be sacrificed, parent artery occlusion can be the most definitive treatment; however, parent artery occlusion is not feasible if the dominant VA or branches like the cerebellar artery or perforator are involved.…”