Clinical Usefulness of Serial Duplex Ultrasound in Cervical Artery Dissection Patients

Abstract

Purpose: To study the clinical usefulness of serial color-coded duplex ultrasound (DUS) examinations in cervical artery dissection (CeAD) patients. Methods: Single-center, CeAD registry-based re-review of serial, routine DUS exams in consecutive CeAD patients treated at the Stroke Center Basel, Switzerland (2009. Two experienced raters reassessed all DUS for the occurrence of new arterial findings during follow-up, that is. (i) recanalization of the dissected artery (if occluded at baseline), (ii) delayed occlusion of a patent dissected artery, and (iii) recurrent CeAD. We studied whether these new arterial findings were associated with clinical symptoms. Results: In 94 CeAD patients (n = 40 female [42.6%], median age 46 years [interquartile range (IQR) 36.2-53]), 506 DUS examinations were reviewed covering a median length of follow-up of 54.1 weeks (IQR 30.5-100.5). In total, 105 dissected arteries were detected, of which 27 (25.7%) were occluded. In 28/94 patients (29.8%), 31 new arterial findings were recorded, which were associated with clinical symptoms in 9/31 (30%) patients. Recanalization of occluded CeAD was observed in 22/27 (81.5%) arteries and occurred in 20/22 arteries within 3 months. In 4/22 patients (18.2%), recanalization was associated with clinical symptoms (ischemic events [n = 2], pure local symptoms [n = 2]). Delayed occlusions were observed in 4/78 (5.1%) dissected arteries patent at baseline. All were clinically asymptomatic and occurred within 14 days from baseline. Recurrent CeAD (all symptomatic) occurred in 5 previously non-dissected arteries. Conclusion: In CeAD patients, follow-up DUS identified new arterial findings, of which several were associated with clinical symptoms: we found that about 1 of 5 recanalizations were associated with clinical symptoms, of whom half were ischemic symptoms. Further, delayed occlusions occurred in patients with no or mild stenosis at baseline and were asymptomatic. This study emphasizes the potential importance of repeated DUS in CeAD particularly in the early phase of up to 4 weeks.

Cervical Artery Dissection and Sports

“…Serial ultrasound examinations in CeAD patients identified the occurrence of new arterial findings, of which several were associated with clinical symptoms in particular in the first 4 weeks. These findings included five recanalizations of initially occluded dissected arteries (50). Although a relationship with sports activities was not reported, these observations suggest an unstable neurovascular situation during which sports activities might be harmful.…”

Extracranial ultrasound following mechanical thrombectomy in patients with acute stroke

“…In all 5 patients with a significantly altered ultrasound result, these findings reflected a normalization of the vessel status. Regression of a local thrombus and carotid artery dissection is a well‐characterized phenomenon 14,15 . Though this is a common finding, it requires sonographic follow‐up to guide appropriate treatment.…”

Recurrent versus first cervical artery dissection – a retrospective study of clinical and vascular characteristics

“…In a recent study of serial ultrasound examinations of CeAD patients, five recurrent events were detected. In all patients with recurrent CeAD, new symptoms were reported [19]. These included newly occurring or new characteristics of headache ( n = 5) with concomitant neck pain ( n = 3) not reported before or with pulsatile tinnitus ( n = 2).…”