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Long-term outcome of cervical artery dissection
Mohammed Janquli1, Logeswaran Selvarajah1, Michael Anthony Moloney1
1Department of Vascular Surgery, University Hospital Limerick, University of Limerick, Limerick, Ireland; Department of Radiology, University Hospital Limerick, University of Limerick, Limerick, Ireland.
Insights
Extracranial cervical artery dissection (CAD) often resolves with conservative management, showing good clinical and anatomical outcomes. Recurrence rates are low, indicating favorable prognosis for most patients.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Extracranial cervical artery dissection (CAD) is a significant cause of stroke in younger adults.
- Understanding its natural history and treatment outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate the natural history of extracranial cervical artery dissection (CAD).
- To analyze comorbidities, presenting symptoms, recurrence, and long-term outcomes.
- To assess different treatment approaches for CAD.
Main Methods:
- Retrospective review of patients treated for acute CAD from January 2017 to April 2022.
- Inclusion of 39 patients with internal carotid or vertebral artery dissection.
- Analysis of clinical presentation, imaging, treatment, and follow-up data.
Main Results:
- Most dissections were spontaneous (87.1%).
- Common symptoms included unilateral weakness, headache, and slurred speech.
- Conservative management (anticoagulation/antiplatelets) led to symptom resolution in 90.9% and anatomical resolution in 76.47% of followed patients.
- Low recurrence rates (four early events) were observed.
Conclusions:
- The majority of extracranial cervical artery dissections (CAD) can be managed conservatively.
- Good clinical and anatomical outcomes are achievable with low recurrence rates.
- Conservative treatment appears effective for managing CAD.
Objective:
The aim of the study is to evaluate the natural history of extracranial cervical artery dissection (CAD) including comorbidities, symptoms at presentation, recurrence of symptoms, and long-term outcome following different treatment approaches.
Methods:
A retrospective review of patients treated for acute CAD was performed over a 5-year period from January 2017 to April 2022.
Results:
Thirty-nine patients were included in the study, 25 (64.1%) with acute internal carotid artery dissection and 14 (35.9%) with acute vertebral artery dissection. Thirty-four patients (87.1%) had spontaneous CAD, and five patients (12.8%) had traumatic CAD. The mean age of the cohort was 54.2 years. The mean time from symptom onset to presentation was 4.34 days. The most common symptoms in internal carotid artery dissection were unilateral weakness (44%), headache (44%), slurred speech (36%), facial droop (28%), unilateral paraesthesia (24%), neck pain (12%), visual disturbance (8%), and Horner's syndrome (8%). The most common symptoms in vertebral artery dissection were headache (35.7%), neck pain (35.7%), vertigo (28.57%), ataxia (14.28%), and slurred speech (14.28%). The imaging modalities used for diagnosis included computed tomography angiography (48.7%), magnetic resonance angiography (41%), and duplex ultrasound (10.2%). In patients with carotid artery dissection, 57% had severe stenosis, 24% had moderate stenosis, and 20% had mild stenosis. All patients treated were managed conservatively with either anticoagulation or antiplatelets. Long-term clinical follow-up was available for 33 patients (84.6%). Thirty patients (90.9%) reported complete resolution of symptoms, and three patients (9%) reported persistent symptoms. Anatomic follow-up with imaging was available for 17 patients (43.58%). Thirteen patients (76.47%) had complete resolution of dissection, two patients (11.76%) had partial resolution of dissection, and two patients (11.76%) had persistent dissection. There was one death unrelated to CAD in a multi-trauma patient. There were four early recurrent symptoms in the first 3 to 8 weeks post discharge. The mean follow-up time was 308.27 days.
Conclusions:
The majority of CADs can be managed conservatively with good clinical and anatomical outcome and low rates of recurrence.
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