Extracranial vertebral artery dissections: a review of 13 cases.

Abstract

Clinical and radiologic findings in 13 patients (11 women, 2 men) with extracranial vertebral artery dissection are reported. Dissection was spontaneous in 8 patients, occurred after neck manipulation in 2 and after a potential minor injury to the neck in 3. Six had a history of common migraine, 4 were using oral contraceptives at the time of dissection, and 3 had fibromuscular dysplasia. Dissection was bilateral in 8 patients and associated with carotid dissection in 3. It usually presented with neck or occipital pain preceding basilar ischemic symptoms by a few minutes to 1 month. In 3 patients, transient ischemic attacks were the only manifestation of basilar ischemia, and in 1 patient there was no symptom of basilar ischemia despite bilateral vertebral dissection. In 19 of the 21 dissected vertebral arteries, the angiographic appearance was that of an irregular stenosis, which was associated in 6 arteries with pseudoaneurysmal formation. In 2 patients, 1 vertebral artery was occluded but the contraiateral artery showed the typical irregular stenosis. The dissection involved only the third segment in 33%, only the second segment in 24%, and 2 or more segments in 38%. Eleven patients were treated with anticoagulants and 2 with aspirin; 11 recovered without sequelae and 2 had residual deficit. No recurrence was observed (mean follow-up 34 months). At control angiography (n = 12) or ultrasonic study (n = 1), 63% of dissected vertebral arteries had returned to normal, 26% showed marked improvement, and 11% were occluded. Our patient characteristics are compared with those of previously published cases. The validity of the distinction between spontaneous dissection and dissection associated with minor trauma is discussed. (Stroke 1987; 18:1037-1047)

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

“…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…”

Dissecção da artéria basilar: relato de caso

“…As dissecções arteriais cérvico-cefálicas são analisadas em vários estudos [1][2][3][4][5][6][7][8] . Atingem comumente as artérias carótidas e são menos frequentes no território vertebrobasilar.…”

“…[1][2][3][4][5][6][7][8] As dissecções arteriais representam parte das etiologias definidas. Essas dissecções atingem as artérias carótidas e vertebrobasilares, sendo pouco frequentes neste último grupo, o envolvimento isolado da artéria basilar uma exceção.…”

Tratamento endovascular das dissecções e pseudoaneurismas da artéria vertebral.

“…No entanto, o sinal mais freqüente é a estenose segmentar de paredes irregulares, muitas vezes gradual, simétrica ou assimétrica, chamada por OJEMAN et al (1972) de "sinal da corda" (FRIEDMAN; DRAKE, 1984;SHIMOJI et al,1984;CHIRAS et al,1985;CAPLAN et al, 1985;CAPLAN et al, 1988;MAS et al, 1990;MOKRI et al, 1988;FLANDRES, 1992 Oclusão abrupta e oclusão após estenose progressiva são sinais angiográficos pouco específicos (MOKRI, 1988;MAS et al, 1990;HINSE et al, 1991;FLANDRES, 1992). Dissecção de mais de um segmento pode ocorrer (MOKRI, 1988;MAS et al, 1990).…”

“…Achados associados que podem ser encontrados incluem displasia fibromuscular (MAS et al, 1990), dissecções da AV contralateral ou da artéria carótida interna (MOKRI, 1988;SCHIEVINK et al, 1994a).…”