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Helical CT for the follow-up of cervical internal carotid artery dissections
X Leclerc1, C Lucas, O Godefroy
1Department of Radiology, University Hospital of Lille, France.
Insights
Helical CT imaging shows that most internal carotid artery (ICA) dissections improve over time. However, some occlusive dissections can lead to persistent narrowing of the ICA.
Area of Science:
- Vascular imaging
- Radiology
- Neurology
Background:
- Internal carotid artery (ICA) dissection is a significant cause of stroke in younger adults.
- Understanding the natural history and imaging changes of ICA dissections is crucial for patient management.
Purpose of the Study:
- To evaluate the longitudinal changes in internal carotid artery (ICA) dissections using helical computed tomography (CT).
- To assess the spontaneous resolution and potential long-term sequelae of ICA dissections.
Main Methods:
- Retrospective analysis of helical CT scans from 27 patients with 30 proven ICA dissections.
- Radiologists independently assessed CT scans for mural thickening, aneurysm formation, and arterial occlusion.
- Follow-up intervals ranged from 7 to 62 months post-angiography.
Main Results:
- Most stenotic or nearly occlusive dissections without aneurysms normalized in diameter.
- Approximately 50% of aneurysms resolved spontaneously.
- Recanalization occurred in 90% of occluded ICAs, but often with persistent narrowing and hypoplasia.
Conclusions:
- Internal carotid artery (ICA) dissection lesions generally show spontaneous improvement or resolution.
- Persistent ICA narrowing can be a late finding, particularly in dissections that were initially occlusive.
Purpose:
The aim of this study was to assess the changes over time of internal carotid artery (ICA) dissections by using helical CT.
Methods:
Twenty-seven patients with 30 angiographically proved ICA dissections were followed up with helical CT at 7 to 62 months (median, 24 months) after conventional angiography. CT scans, analyzed independently by two radiologists in a blinded fashion, were evaluated for the presence of mural thickening, aneurysmal formation, and arterial occlusion. In cases without persisting occlusion or aneurysm, we measured the external diameter of the ICA at its upper segment.
Results:
The interobserver agreement was good. Mild mural thickening was observed in four cases of 30 previously dissected ICAs. All stenotic and nearly occlusive dissections without an aneurysm (n = 12) reverted to a normal or nearly normal diameter. Half the aneurysms resolved spontaneously (four of eight). Of the 10 occluded ICAs, nine were recanalized, but their external diameter was significantly smaller than that of normal carotid arteries, and a hypoplastic appearance was seen throughout the cervical segment of the ICA in three cases.
Conclusion:
Most arterial lesions tend to improve or disappear spontaneously, but persisting ICA narrowing may be observed in the late course of occlusive-type dissections.