[Clinical characteristics of internal carotid and vertebral arteries dissection]

To compare demographic, clinical, and imaging characteristics of patients with internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD) in a Russian population.

One hundred fifty-two consecutive patients (74 males, 49%; mean age - 37.0±10.3 years) with cervical artery dissection (ICAD - 85 patients, 56%; VA - 62 patients, 41%; ICA+VA - 5 patients - 3%) verified by MRI/MRA were studied. Five patients with both ICAD and VAD were excluded from analysis.

Patients with ICAD more often were men (63%, p<0.0001), while patients with VAD were women (69%, p<0.0001), age distribution was similar (37.4±11.2 and 36.2±9.4 years, p>0.05). The main precipitating events for VADs were neck movements, prolonged static turning of the head, physical exertion (57% vs 28% in ICAD, p=0.0009). Head trauma within the previous month was more often reported by ICAD patients than VAD patients (21% vs 7%, p=0.0295). Clinically ICADs more frequently manifested by ischemic stroke (IS) then VADs (82% vs 55% p=0.0004), but more rarely by isolated cervical pain/headache (10% vs 35%, p<0.0001). 85% patients with dissections had neck/headache preceding cerebral ischemia: isolated neck pain (27%, p=0.0001) or a combination of neck pain with headache (55%, p=0.0004) were characteristic of VADs while headache was typical for ICADs (71%, р=0.0001). According to MRI, bilateral ICADs were found more rarely than bilateral VADs (10% vs 31% p=0.0029). Arterial occlusion was more common for ICADs (61% vs 20%, p<0.0001), double lumen was found only in VAD patients (6%, p=0.0121), and aneurysms were revealed with similar frequency (ICAD 7%, VAD 5%).

There were significant differences between patients with ICAD and VAD in terms of gender distribution, precipitating events, clinical and imaging features. Different embryonic origin of ICA and VA, their anatomical differences, and intramural hematoma location in relation to intima and adventitia may underlay these differences.