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Structural Changes of Intra and Extracranial Artery Dissection: a Study of High-Resolution Magnetic Resonance Imaging
Kwon Hanim1, Seung Chai Jung2, Chang Jun Young3
1Department of Neurology, Korea University Ansan hospital, Korea University College of Medicine, Ansan, South Korea; Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Insights
Extracranial artery dissection shows better outcomes than intracranial dissection, with more frequent stenosis improvement and less wall enhancement. Extracranial location independently predicts improved stenosis in dissection patients.
Area of Science:
- Neuroscience
- Vascular Medicine
- Radiology
Background:
- Cerebral artery dissection prognosis is generally benign, but vessel wall structural changes at follow-up remain understudied.
- Intracranial and extracranial artery dissections may exhibit distinct natural courses due to anatomical differences.
Purpose of the Study:
- To investigate the differences in stenosis and other vessel wall features between intracranial and extracranial artery dissections.
- To identify factors associated with changes in stenosis following dissection.
Main Methods:
- Retrospective enrollment of patients with ischemic stroke or TIA due to dissection, with initial and follow-up high-resolution magnetic resonance imaging (HRMRI).
- Dichotomization of patients into intracranial or extracranial dissection groups for comparative analysis.
- Clinical and HRMRI characteristics were compared, and factors influencing stenosis changes were examined.
Main Results:
- The extracranial dissection group (n=14) showed significantly more frequent stenosis improvement (85.7%) compared to the intracranial group (n=43, 27.9%).
- Residual wall enhancement and intramural hematoma were less common in extracranial dissections.
- Multivariate analysis identified extracranial location as the sole independent predictor of stenosis improvement (OR 8.98, P=0.02).
Conclusions:
- Extracranial artery dissections are associated with younger patient age, greater stenosis improvement, and reduced wall enhancement and intramural hematoma compared to intracranial dissections.
- Extracranial location is an independent factor associated with improved stenosis in patients with dissection.
Objectives:
The prognosis of a cerebral artery dissection is known to be benign, but the structural changes of vessel wall at follow-up are not well known. The natural course of an intracranial and extracranial artery dissection may differ due to structural differences. We aimed to figure out how stenosis and other wall features change, according to the dissection location.
Materials And Methods:
We retrospectively enrolled patients who suffered an ischemic stroke or transient ischemic attack due to a dissection and who had undergone both initial and follow-up high-resolution magnetic resonance imaging (HRMRI). Patients were dichotomized to intracranial or extracranial dissection group. The clinical and HRMRI characteristics of two groups were compared. Factors associated with stenosis changes were also investigated.
Results:
A total of 57 patients (intracranial, n = 43; and extracranial, n = 14) were enrolled. The mean age (45.6 vs. 32.2, p < 0.001) was higher and hypertension (37.2% vs. 7.1%, p = 0.04) was more frequent in the intracranial dissection group. In HRMRI analysis, stenosis improvement (27.9% vs. 85.7%, p < 0.001) were more frequent whereas residual wall enhancement (86.0% vs. 46.2%, p = 0.006) and intramural hematoma (62.8% vs. 21.4%, p = 0.007) were less frequent in the extracranial dissection group. Multivariate analysis indicated that extracranial location was the only independent factor (odds ratio 8.98, 95 % confidence interval 1.45-55.65; p = 0.02) associated with stenosis improvement.
Conclusions:
Younger age, stenosis improvement, disappearance of wall enhancement and intramural hematoma were more frequent in an extracranial dissection compared with an intracranial dissection. An extracranial location is independently associated with stenosis improvement in dissection patients.
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