Internal carotid and vertebral artery dissections - a comparison of clinical, radiological and prognostic
Justyna Kos1, Michał Kos2, Jacek Jaworski2
1Chair and Department of Neurology, Medical University of Lublin, Poland. justyna.drankowska@gmail.com.
Insights
Internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD) show distinct clinical and radiological differences. VAD patients experienced more ischemic events, while ICAD patients had higher rates of Horner syndrome.
Area of Science:
- Neurology
- Vascular Neurology
- Cerebrovascular Disease
Background:
- Cervical artery dissection (CeAD) is a leading cause of stroke in young adults.
- CeAD presents with variable clinical courses, complicating diagnosis.
- Differentiating internal carotid artery dissection (ICAD) from vertebral artery dissection (VAD) is crucial.
Purpose of the Study:
- To compare baseline characteristics, risk factors, symptoms, imaging findings, and outcomes between ICAD and VAD.
- To identify distinct features of ICAD versus VAD.
- To improve diagnostic accuracy and patient management for CeAD.
Main Methods:
- Retrospective analysis of 31 CeAD patients (18 ICAD, 13 VAD) from 2008-2018.
- Diagnosis confirmed by appropriate imaging.
- Comparison of clinical presentation, radiological features, and long-term outcomes.
Main Results:
- ICAD patients more frequently presented with Horner syndrome (44.4% vs 7.6%).
- VAD patients had more ischemic events (84.6% vs 44.6%) and higher rates of occlusion (69.2% vs 22.2%).
- More severe strokes occurred in ICAD patients (median NIHSS 6 vs 4).
Conclusions:
- Significant differences exist between VAD and ICAD in clinical symptoms and radiological presentation.
- These findings aid in distinguishing between ICAD and VAD.
- Understanding these differences can refine diagnosis and treatment strategies for CeAD.
Aim Of Study:
To examine whether baseline characteristics, potential risk factors, clinical symptoms, radiological presentation, and long-term outcomes differ between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD).
Clinical Rationale For Study:
Cervical artery dissection (CeAD) is a major cause of cerebral ischaemia in young adults. Its clinical course is highly variable, resulting in challenges in making a proper diagnosis.
Methods:
We performed a retrospective analysis of 31 patients (mean age 42.2 years) with CeAD (18 with ICAD, 13 with VAD) treated in our neurology department from 2008 to 2018. Appropriate imaging confirmed the diagnosis of CeAD.
Results:
Patients with ICAD presented Horner syndrome significantly more often (44.4% vs 7.6%; p = 0.04). Patients with VAD more often had ischaemic events (ischaemic stroke, TIA or transient blindness) (84.6% vs 44.6%; p = 0.0032). Ischaemic stroke was more severe in patients with ICAD [(median NIHSS 6, interquartile range 4-12) vs VAD (median NIHSS 4, interquartile range 1.5-5.5), p = 0,03]. Occlusion occurred more often in patients with VAD (69.2% vs 22.2%; p = 0.013). Most patients had a favourable outcome (mRS 0-2).
Conclusions And Clinical Implications:
In a series of patients with CeAD, we observed significant differences between VAD and ICAD in terms of clinical symptoms and radiological features.
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