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Initial and follow-up high-resolution vessel wall MRI study of spontaneous cervicocranial artery dissection
Xuehua Lin1, Wei Guo1, Dejun She1
1Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China.
Insights
Spontaneous cervicocranial artery dissection (sCCAD) factors like intraluminal thrombus and incomplete circle of Willis increase stroke risk. High-resolution vessel wall MRI aids in understanding sCCAD evolution and patient outcomes.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Spontaneous cervicocranial artery dissection (sCCAD) is a significant cause of ischemic stroke, particularly in younger adults.
- Understanding the factors associated with stroke occurrence and the evolution of sCCAD is crucial for effective patient management.
Purpose of the Study:
- To identify clinical and initial imaging factors associated with ischemic stroke in patients with sCCAD.
- To evaluate initial imaging markers that predict anatomical outcomes in sCCAD.
Main Methods:
- Retrospective analysis of high-resolution vessel wall MRI (VW-MRI) in patients with sCCAD.
- Logistic regression models were used to assess associations between clinical/imaging factors and stroke occurrence.
- Anatomical outcomes were categorized, and ordinal logistic regression analyzed associations with initial features.
Main Results:
- Intraluminal thrombus and incomplete/partial circle of Willis (COW) were independently associated with increased stroke risk.
- Pseudoaneurysm showed a trend towards lower stroke risk.
- Double lumen and occlusion were linked to no remodeling of the dissected artery.
Conclusions:
- Initial clinical and imaging findings, including COW status, are significant predictors of stroke in sCCAD.
- Follow-up VW-MRI offers valuable insights into the long-term evolution and anatomical outcomes of sCCAD.
- VW-MRI features can guide optimal management strategies for sCCAD patients.
Objectives:
To explore the factors associated with ischemic stroke secondary to spontaneous cervicocranial artery dissection (sCCAD) and evaluate the initial imaging markers related to outcomes.
Methods:
Initial and follow-up high-resolution vessel wall MRI (VW-MRI) in consecutive patients with sCCAD were retrospectively analyzed. The associations of clinical and imaging factors and variants of the circle of Willis (COW) with ischemic stroke were evaluated using binary logistic regression analyses. The anatomical outcomes were categorized as complete, partial, and no remodeling based on changes of the vessel wall and lumen. Ordinal logistic regression analysis was used to assess associations between initial features and outcomes.
Results:
A total of 115 dissected arteries (79 strokes, 36 non-strokes) were detected in 103 patients. Follow-up VW-MRI was available in 46 patients (44.7%, with 51 vessels), with a median interval of 8.5 months. Pseudoaneurysm (odd ratio [OR], 0.178; 95% confidence interval [CI], 0.039-0.810; p = 0.026) tended to rarely cause ischemic stroke, while intraluminal thrombus (OR, 5.558; 95% CI, 1.739-17.765; p = 0.004), incomplete COW (OR, 9.309; 95% CI, 2.122-40.840; p = 0.003), and partial complete COW (OR, 4.463; 95% CI, 1.211-16.453; p = 0.025) were independently associated with stroke occurrence. Furthermore, the presence of double lumen (OR, 5.749; 95% CI, 1.358-24.361; p = 0.018) and occlusion (OR, 12.975; 95% CI, 3.022-55.645; p = 0.001) were associated with no remodeling of sCCAD.
Conclusions:
Multiple initial factors were found to be related to stroke occurrence and anatomical outcomes of sCCAD. High-resolution VW-MRI may provide valuable insights into the pathophysiology and evolution of sCCAD.
Clinical Relevance Statement:
Initial and follow-up high-resolution vessel wall MRI may help elucidate the pathophysiology of spontaneous cervicocranial artery dissection and provide important insights into the evolution and further facilitate the optimal management of patients with spontaneous cervicocranial artery dissection.
Key Points:
• Clinical and imaging factors, as well as the status of primary collateral circulation, are associated with ischemic stroke secondary to spontaneous cervicocranial artery dissection. • The follow-up high-resolution vessel wall MRI provides valuable insights into the long-term evolution and anatomical outcomes of spontaneous cervicocranial artery dissection. • The high-resolution vessel wall MRI features related to ischemic stroke and anatomical outcomes may further facilitate the optimal management of patients with spontaneous cervicocranial artery dissection.
