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Published on: July 21, 2013
[Cervicocranial arterial dissection. Experience in 57 patients]
Andrés Gallardo V1, René Núñez F2, Osvaldo Trujillo1
1Servicio de Neurología Clínica INDISA, Santiago, Chile.
Insights
Cervicocranial arterial dissection (CIAD) often presents without stroke symptoms, enabling earlier management. This study details CIAD patient characteristics, revealing a high rate of favorable outcomes with timely treatment.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Cervicocranial arterial dissection (CIAD) is a significant cause of ischemic stroke.
- Understanding CIAD's clinical and imaging features is crucial for timely diagnosis and management.
Purpose of the Study:
- To characterize the clinical and imaging presentation of patients diagnosed with cervicocranial arterial dissection (CIAD).
- To analyze patient outcomes and treatment strategies for CIAD.
Main Methods:
- A retrospective analysis of an anonymous registry of patients diagnosed with CIAD.
- Patients were categorized into anterior circulation dissection (ACD) and posterior circulation dissection (PCD) groups.
- Clinical data, imaging findings, and treatment outcomes were collected and analyzed.
Main Results:
- Fifty-seven patients (40 ± 8 years, 60% women) were included, with 39 in the PCD group and 18 in the ACD group.
- Cervical pain was the most frequent symptom; 49% of patients had no stroke symptoms at diagnosis.
- A favorable outcome (Modified Rankin Scale 0-2) was achieved in 85.9% of patients, with a trend towards better prognosis in PCD.
Conclusions:
- The increased availability of non-invasive imaging allows for the diagnosis of CIAD in 50% of patients without overt stroke.
- Earlier detection and timely management of CIAD are feasible, potentially improving patient outcomes.
Background:
Cervicocranial arterial dissection (CIAD) is an important cause of stroke.
Aim:
To describe the clinical and imaging characteristics of patients with CIAD.
Material And Methods:
An anonymous registry was made including all patients admitted to a private hospital with a diagnosis of CIAD. Patients were subdivided as having an anterior or posterior circulation dissection (ACD or PCD, respectively).
Results:
Fifty-seven patients aged 40 ± 8 years (60% women) were included in the study, 39 with PCD and 18 with ACD. Cervical pain was the most common symptom. CIAD was diagnosed with no clinical or imaging signs of stroke in 49% of patients. Fifty one percent of patients had focal neurological deficits and 72% had a NIH stroke score below five. No significant differences between patients with ACD or PCD were found. Fifty patients received antiplatelet therapy (simple or dual), seven patients were anticoagulated and 13 were subjected to stenting due to progression of stenosis with hemodynamic involvement or bilateral dissection with scarce collaterals. The lesion was located in V3 segment in 27 patients and cervical segment of the internal carotid in 16 cases. A favorable Modified Rankin Scale (0-2) was achieved in 85.9%, with a trend towards achieving better functional prognosis in PCD.
Conclusions:
Due to the greater availability of non-invasive imaging methods, 50% of these patients with CIAD did not have a stroke. Thus, an earlier and more timely management is feasible.
