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Updated: Jun 11, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Intracranial arterial dissections in ischemic stroke assessed by 3D rotational angiography
Shoji Matsumoto1, Tatsuro Takada, Masahiro Yasaka
1Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan. shoji-matsumoto@384.jp
Insights
Three-dimensional rotational angiography (3D-RA) significantly improves the detection of intracranial arterial dissections (ICADs) compared to conventional digital subtraction angiography (DSA). 3D-RA is particularly valuable for visualizing dissections in smaller arteries.
Area of Science:
- Neuroradiology
- Vascular Imaging
- Interventional Neurology
Background:
- Conventional digital subtraction angiography (DSA) has limitations in assessing intracranial arterial dissections (ICADs).
- Three-dimensional rotational angiography (3D-RA) offers a potential alternative for improved visualization.
Purpose of the Study:
- To evaluate the diagnostic value of 3D-RA in comparison to DSA for ICADs.
- To assess the conspicuity of specific dissection signs (double lumen, pearl and string, string sign, aneurysmal dilatation) with both imaging modalities.
Main Methods:
- Retrospective analysis of 39 patients diagnosed with ICADs who underwent both DSA and 3D-RA.
- Blinded comparison of 3D-RA and DSA images.
- Stratification of patients into smaller (S group) and larger (L group) artery groups based on dissection caliber.
Main Results:
- 3D-RA showed a significantly higher detection rate for the double lumen sign (79%) versus DSA (18%).
- Overall reliable dissection findings were more frequent with 3D-RA (90%) than DSA (36%).
- The double lumen sign in smaller arteries was exclusively detected by 3D-RA.
Conclusions:
- 3D-RA enhances the conspicuity of intracranial arterial dissections compared to conventional DSA.
- 3D-RA is especially beneficial for diagnosing ICADs in smaller-caliber intracranial arteries.
Background:
Dissections involving intracranial arteries are sometimes difficult to assess using conventional digital subtraction angiography (DSA). We evaluated the value of three-dimensional rotational angiography (3D-RA) for the assessment of intracranial arterial dissections (ICADs).
Methods:
The subjects were 39 patients (26 males, 13 females; average age 50+/-15years) who were diagnosed as having ICADs and who underwent both DSA and 3D-RA in our hospital between April 1999 and March 2005. We retrospectively compared 3D-RA images to conventional DSA images in a blinded manner with respect to double lumen sign, pearl and string sign, string sign, and aneurysmal dilatation. On the basis of the caliber size of the artery affected by dissections, we divided patients into two groups: smaller artery group (S group) and larger artery group (L group).
Results:
The detection rate of double lumen sign with 3D-RA (79%) was significantly higher than with conventional DSA (18%; P<0.001). Reliable findings of arterial dissections (double lumen sign and/or pearl and string sign) were observed more often with 3D-RA (90%) than with conventional DSA (36%; P<0.001). In S group, the double lumen sign was detected only with 3D-RA.
Conclusions:
3D-RA allows increased conspicuity of ICADs findings with conventional DSA, especially in smaller-caliber intracranial arteries.
