Association between carotid artery dissection and vascular tortuosity: a case-control study

Area of Science:

• Vascular Neurology
• Radiology
• Cardiovascular Research

Background:

• Spontaneous epiaortic vessel dissection (sEVD) is a significant cause of stroke in young adults.
• Vascular tortuosity (VT) has been anecdotally linked to dissections, but its role as a risk factor requires investigation.

Purpose of the Study:

• To determine if vascular tortuosity (VT) is a risk factor for spontaneous epiaortic vessel dissection (sEVD) in patients under 55.
• To identify a potential threshold for vascular tortuosity index (VTI) associated with increased dissection risk.

Main Methods:

• Retrospective analysis of 304 young adult stroke patients.
• 3D CT-angiography reconstructions used to measure VT in carotid and vertebral arteries.
• Comparison of vascular tortuosity index (VTI), kinking, and coiling between sEVD cases and controls.

Main Results:

• Vascular tortuosity index (VTI) was significantly higher in carotid arteries of sEVD cases compared to controls (p=0.029).
• No significant difference in kinking or coiling rates between cases and controls.
• A VTI threshold of 27.9% was identified as a significant predictor for carotid artery dissection (AUC=61.6%, p=0.04).

Conclusions:

• Vascular tortuosity (VT) is associated with an increased risk of carotid artery dissection, but not vertebral artery dissection.
• The distinct anatomical and pathophysiological characteristics of carotid and vertebral arteries may explain these findings.
• Further validation in larger cohorts is needed to confirm VTI as a predictor for carotid artery dissection.