Internal Carotid Artery S-Shaped Curve as a Marker of Fibromuscular Dysplasia in Dissection-Related Acute Ischemic Stroke

Abstract

Background and Purpose: Craniocervical fibromuscular dysplasia (FMD) is associated with dissections and with S-shaped curves in the internal carotid artery (ICA). We evaluated the occurrence of S-curves in patients presenting with acute strokes due to ICA steno-occlusive dissections. Methods: This was a retrospective review of the interventional databases of two academic tertiary-care institutions. The presence of ICA S-shaped curves, C-shaped curves, 360-degree loops, as well as classic FMD and atherosclerotic changes at the ICA bulb and curve/loop was determined. Cases of carotid dissections were compared with a control group (consecutive non-tandem anterior circulation strokes). Results: Twenty-four patients with carotid dissections were compared to 92 controls. Baseline characteristics and procedural variables were similar, with the exception of younger age, less frequent history of hypertension, diabetes, atrial fibrillation and stent retriever use in patients with dissections. The rates of mTICI2b-3 reperfusion, parenchymal hematoma, good outcome and mortality were similar amongst groups. The frequency of S-curves (any side without superimposed atherosclerosis) was 29% in the dissection group versus 7% in controls (p < 0.01). S-curves were typically mirror images within the dissection group (85% had bilateral occurrence). The frequency of C-shaped and 360-degree curves was similar between groups. FMD changes within the craniocervical arteries were statistically more common in dissection patients. Ten patients (41%) of the dissection group had S-curves or classic FMD changes. Multivariate analysis indicated that S-curves were independently associated with the presence of dissections. Conclusion: S-shaped ICA curves are predictably bilateral, highly associated with carotid dissections in patients with moderate to severe strokes, and may suggest an underlying presence of FMD.

Spontaneous Cervical Artery Dissection in Vascular Ehlers-Danlos Syndrome

“…15,16 This tortuosity pattern (the S-shaped curve) has been described in fibromuscular dysplasia and highly associates with carotid dissection. 17,18 Arterial tortuosity has also been reported in the Loeys-Dietz syndromes especially on vertebral arteries, but it is not specific to vEDS and we found a low prevalence in our cohort.…”

Hypoglossal Canal Dural Arteriovenous Fistula Induced after Mechanical Thrombectomy for Acute Ischemic Stroke

“…DAVFs are characterized by abnormal arteriovenous shunts on the dura mater, but those of the hypoglossal canal (HCDAVFs), are classified as ventral-type fistulas according to Lasjaunias' classification with fibromuscular dysplasia (FMD). 3,4) FMD is a vascular lesion typically characterized by the "string of beads sign," which reflects stenosis and dilation of the ICA, or long tubular stenosis. One study reported that the incidence of S-shaped ICA in patients with FMD was higher than in healthy adults.…”

“…2) Furthermore, another study indicated that dissection of the ICA was frequently observed when bilateral S-shaped ICAs were detected on cerebral angiography in patients with acute ischemic strokes. 3) FMD is common in women aged 40-60 years. Our patient was male, but the presence of FMD as a background factor was suggested.…”

Pediatric subarachnoid hemorrhage and aneurysm caused by fibromuscular dysplasia

“…1c). 3 Although antihypertensive treatment was initiated, her blood pressure was difficult to control; we therefore performed additional tests to determine its cause. Magnetic resonance angiography revealed left renal artery stenosis (Fig.…”