Comparison of Potential Risks between Intracranial and Extracranial Vertebral Artery Dissections

Abstract

Background/Aims: To better understand potential risks for vertebral artery (VA) dissection (VAD), we compared intracranial and extracranial VADs. Methods: We analyzed consecutively admitted VAD patients over a 9-year period in whom VAD was confirmed by angiography. All patients were categorized as having intracranial or extracranial VAD, and demographic and radiological characteristics of VAD were compared. We used multivariate analysis to predict the risks for intracranial and extracranial VADs. Results: The study population (n = 74) had a mean age of 46.0 ± 10.3 years. VAD was more frequent in the nondominant VA (n = 49, 66.2%). Vertical nidus of VAD was more common in the intracranial segment (81.1%), and more particularly it was most frequently located within a 2-mm perimeter of the posterior inferior cerebellar artery (PICA) orifice (60.0%). Absence of traumatic history (OR 13.1, 95% CI 1.6-107.4; p = 0.016), history of hypertension (OR 14.1, 95% CI 1.1-184.6; p = 0.043) and aging (OR 1.1 per 1-year increase, 95% CI 1.0-1.2; p = 0.038) were independent predictors of intracranial VAD. Conclusion: As compared to extracranial VAD, intracranial VAD was particularly frequent and particularly vulnerable at the perimeters of the PICA and nondominant VA and was associated with an absent trauma history, hypertension and aging. Formation of VAD appeared to be different according to intracranial or extracranial involvement.

Endovascular Therapy for Ruptured Vertebral Artery Dissecting Aneurysms: Results from Nationwide, Retrospective, Multi-Center Registries in Japan (JR-NET3)

“…Though we cannot determine the exact reason why the proportion of males decreased, improved recognition of blood pressure control in Japan may have contributed, as hypertension is one of the risk factors for intracranial VA dissection. 8,9) The increase in the number of patients with severe SAH treated with EVT might be derived from the increased availability of endovascular specialists who recognize the effect of EVT even in patients with severe SAH, as more than 30% patients can achieve favorable outcome. 10–12) The gradual increase in the proportion of patients receiving early treatment within 24 h (49.2%, 74.3%, and 80.0% in JR-NET1, 2, and 3, respectively) might be also due to more widespread availability of trained neuroendovascular specialists in Japan.…”

Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection

“…No comparisons exist between putative risk factors in patients with intracranial artery dissection and healthy controls. In the few studies that included both patients with cervical artery dissection and those with intracranial artery dissection, distribution of vascular risk factors did not diff er between the two groups, 31 except for one study 37 showing a higher prevalence of hypertension in patients with intracranial artery dissection. However, this fi nding 37 might be accounted for by the older age of patients with intracranial artery dissection than control participants in that study (mean age 48 years vs 37 years).…”

“…In two studies 25,37 that compared patients with cervical artery dissection and patients with intracranial artery dissection, a history of minor trauma was more often present in patients with cervical artery dissection, both in children and adults. In our experience, sudden physical movements that lead to a sudden stretch of the arteries are sometimes reported before the event, but this association has not been systematically analysed in large patient series.…”

“…Recurrent bleeding was reported in 0-11% of patients with intracranial artery dissection with subarachnoid haemorrhage after surgical or endovascular treatment, and after treatment for ischaemia in 0-22% of patients. 19,[21][22][23][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Cranial nerve palsies and spinal cord infarctions were seldom reported. 35,41,93 Overall, of 813 endovascular procedures, 50 (6•2%) cerebral or spinal cord ischaemia, 15 (1•8%) rupture and rebleeding, and seven (0•9%) cases of cranial nerve palsies were reported; of 125 surgical procedures, 23 (18•4%) cerebral or spinal cord ischaemia, one (0•8%) rupture and rebleeding, and one (0•8%) case of cranial nerve palsy were reported.…”

“…Overall, more than 79% of patients with intracranial artery dissection and without subarachnoid haemor rhage had a favourable functional outcome (modifi ed Rankin Scale ≤1 or ≤2, or equivalent). 19,[21][22][23][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] One study 21 showed that …”