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Changes in Vertebrobasilar Artery Dissection Visible with High-Resolution Vessel Wall Imaging: A Serial Follow-Up
Eunjeong Cho1, Youjin Won1, Ui Yun Lee2
1Jeonbuk National University Medical School, Jeonju 54907, Republic of Korea.
Insights
High-resolution vessel wall imaging (HR-VWI) reveals healing in most vertebrobasilar artery dissections (VBADs) over time. Intimal flaps and double lumens often disappear, indicating a positive recovery process.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- Vertebrobasilar artery dissections (VBADs) are identifiable with high-resolution vessel wall imaging (HR-VWI).
- While VBADs are clinically benign, their serial changes on HR-VWI remain uncharacterized.
Purpose of the Study:
- To evaluate the longitudinal changes in VBADs using HR-VWI.
- To understand the natural course of VBADs through serial imaging follow-up.
Main Methods:
- Retrospective enrollment of patients with symptomatic VBADs and initial/follow-up HR-VWI.
- Serial HR-VWI follow-up at 3, 6, 12, and 24 months post-symptom onset.
- Classification of follow-up findings into wall thickness (type 1), no change (type 2), or occlusion (type 3).
Main Results:
- Fifteen patients (median age 50) were analyzed, all initially showing intimal flaps and double lumens.
- During follow-up, 60% showed wall thickening (type 1), 33.3% had no interval change (type 2), and one had occlusion (type 3).
- Nine patients (60%) demonstrated healing, characterized by intimal flap attachment to the vessel wall.
Conclusions:
- VBADs exhibit dynamic changes detectable by HR-VWI during follow-up.
- The majority of VBADs demonstrate a healing process, including resolution of intimal flaps and double lumens.
Background:
High-resolution vessel wall imaging (HR-VWI) can identify vertebrobasilar artery dissections (VBADs) due to its good intramural hematoma and intimal flap visualization. Although the clinical course of VBADs is known to be benign, changes in VBADs visible using HR-VWI at follow-up are unknown. Thus, this study aimed to assess serial changes in VBADs using HR-VWI at follow-up.
Materials And Methods:
Patients with neurological symptoms from VBADs who had undergone both initial and follow-up HR-VWI examinations were retrospectively enrolled. Enrolled patients with VBADs at the initial HR-VWI after acute symptom onset underwent serial follow-up with HR-VWI at 3, 6, 12, and 24 months. Patients were classified into three groups based on the results of follow-up HR-VWI examinations: type 1 = wall thickness of the dissected artery; type 2 = no interval change; and type 3 = occlusion.
Results:
Fifteen patients (median age: 50 years, nine males) were enrolled in this study. All patients initially showed an intimal flap and a double lumen. Twelve (80%) patients showed strong wall enhancement. Nine (60%) patients had an intramural hematoma. During serial follow-up, nine (60.0%) patients showed type 1 lesions due to attachment of the intimal flap to the vessel wall, five (33.3%) showed type 2, and one showed type 3. Four patients with BA dissection showed type 2 lesions without change in the intimal flap or the double lumen.
Conclusions:
Changes in VBADs in HR-VWI were observed during the follow-up period. Most patients with VBADs showed the healing process, such as the disappearance of the intimal flap and the double lumen.
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