Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection

Abstract

Background Cervicocerebral artery dissection is an important cause of ischemic stroke in young and middle-aged individuals. However, very few studies have compared the differential features between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD), including both cervical and intracranial artery dissections. We conducted a study to investigate the predisposing factors and radiological features in patients with ICAD or VAD. Methods All cases diagnosed with cervicocerebral artery dissection, ICAD, or VAD were identified through a medical records database, between January 2010 and January 2020. Baseline characteristics, predisposing factors, and radiological features of ICAD versus VAD were compared. Results A total of 140 patients with cervicocerebral artery dissection were included in the study, including 84 patients in the ICAD group and 56 in the VAD group. The mean age of patients in the ICAD and VAD groups was 43.37 ± 14.01 and 41.00 ± 12.98 years old, respectively. Patients with ICAD were more likely to be men compared with VAD (85.71% vs. 67.86%, p = 0.012). The frequency of hypertension, diabetes, smoking, drinking, and cervical trauma did not differ between ICAD and VAD. Dissections of ICAD were more frequently at the extracranial portions of the artery compared with those of VAD (70.24% vs. 44.64%, p = 0.003). In contrast, dissections of VAD were more common in the intracranial artery (55.36% vs. 29.76%, p = 0.003). Radiologically, double lumen (36.90% vs. 19.64%, p = 0.029) and intimal flap (11.90% vs. 1.79%, p = 0.029) were more frequently observed in ICAD than in VAD, and dissecting aneurysms were less frequent (13.10% vs. 26.79%, p = 0.041). Conclusions The distributions of cervical and intracranial artery dissections were different between ICAD and VAD. The frequencies of radiological features detected in patients with ICAD and VAD also differed.

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

“…Compared with the cervical artery, the intracranial artery relatively lacks elastic fibers in the media and adventitial tissue and has no external elastic layer [ 8 , 33 ]. Therefore, intracranial dissection is more likely to develop dissecting aneurysms due to the lack of supporting tissue in the vessel [ 34 ]. The reason why aneurysms are more commonly found in the posterior circulation in the intradural dissection is still unclear.…”

“…8,33 Therefore, intracranial dissection is more likely to develop dissecting aneurysms due to the lack of supporting tissue in the vessel. 34 The reason why aneurysms are more commonly found in the posterior circulation in the intradural dissection is still unclear.…”

Natural History of Unruptured Vertebral Basilar Artery Dissection: Temporal Changes in Imaging Findings and Contributory Factors

“…It has also been shown that the risk of recurrent cerebral infarction or arterial dissection is low after 3-6 months [27,28]. Antiplatelet and anticoagulant therapies are therefore particularly recommended to prevent recurrence only during the period from 3 to 6 months after onset [27,29]. If possible, imaging investigations should be conducted every 3 months, and the necessity of antiplatelet or anticoagulant therapy and the choice of drug should be considered based on the resulting ndings.…”

“…In the event of arterial dissection, however, the inner surface of the vascular lumen becomes smooth as a result of the repaired intima, and with this structure, thrombi are unlikely to form. It has also been shown that the risk of recurrent cerebral infarction or arterial dissection is low after 3-6 months [27,28]. Antiplatelet and anticoagulant therapies are therefore particularly recommended to prevent recurrence only during the period from 3 to 6 months after onset [27,29].…”

“…In principle, if signs of stenosis at the dissection site are still present after at least 6 months, drugs should be continued. If imaging ndings have completely normalized, and the dissection site has ceased to show further changes, it may be appropriate to consider discontinuing medications [1,[16][17][18][19]27,28].…”