Long-term follow-up of occlusive cervical carotid dissection.

Abstract

We retrospectively studied 19 cases of occlusive cervical carotid dissection encountered at our hospital between 1974 and 1984 and followed for 5-13 (mean 8.2) years to assess the long-term prognosis of the disease. Five patients had transient ischemic attacks, seven had minor stroke, six had major stroke, and one had epileptic seizures. Angiography demonstrated the typical string sign in 17 cases, a double lumen with occlusion in one, and multiple scalloped narrowings with distal occlusion in the other. Three patients died within 1 month and three remain severely disabled (overall mortality and major morbidity 32%), five have permanent deficits, and seven are neurologically intact; the remaining patient was lost to follow-up. Five patients were treated surgically (two had extracranial-intracranial bypass and three had cervical carotid exploration), and the other 14 were treated medically. The overall rate of reopening was 47% with eight of 10 patients demonstrating recanalization on control angiography and another patient demonstrating recanalization at surgery. These nine patients remain clinically stable on follow-up evaluations. However, vascular abnormalities in the healed arteries were notable and include kinking, nbromuscular dysplasia, dissecting aneurysms, intracranial occlusion, and a residual mural defect (Stroke 1990;21:528-531)

Ruptured Dissecting Aneurysm of the Vertebral Artery Associated With Occlusive Internal Carotid Artery Dissection. Case Report.

“…7,14) The reopening rate is satisfactory in occlusive cervical carotid artery dissections, and recanalization can occur within 1 month. 1,11) In our case, the ICA stenosis resolved spontaneously, but enlargement of the right VA dissecting aneurysm indicated surgery. This lesion was effectively managed by endovascular VA proximal occlusion.…”

“…1,3,[6][7][8][9][11][12][13][14][15] Multiple dissections occur predominantly in patients with fibromuscular dysplasia, trauma, or some other underlying disorders, and can be successfully treated. 2,6,8,12,13) However, multiple dissections can also occur in patients without such predisposing factors.…”

Vertebral Artery Dissection

“…1,4,24 and sICAD. [25][26][27] Low baseline NIHSS score and younger age were independent predictors of a favorable outcome. In contrast to previous series, intracranial location of sVAD and bilateral sVAD did not predict an unfavorable clinical outcome in our study.…”

“…The cutoff in the univariate analyses as requirement for inclusion in the multivariate analyses was PϽ0. 25. Median time interval from symptom onset to diagnosis was 4 days (range, 2 hours to 88 days).…”

Early Activation of Intracranial Collateral Vessels Influences the Outcome of Spontaneous Internal Carotid Artery Dissection

“…6,23,24 The finding of high mortality 25 or very poor outcome rates 26 in some studies raised the suspicion that ICA dissection may be underestimated owing to the lack of or delay in the diagnosis during the acute phase, especially in patients with severe clinical presentations. 1 In this respect, the extent of cerebral ischemia and the presence of arterial occlusion represent the 2 main factors unfavorably influencing prognosis and reducing the rate of correct diagnoses.…”