Intracranial Vertebral Artery Dissections: Evolving Perspectives

Ali, Muhammad; Amenta, Peter S.; Starke, Robert M.; Jabbour, Pascal; Gonzalez, L. Fernando; Tjoumakaris, S; Flanders, Adam E.; Rosenwasser, Robert H.; Dumont, Aaron S.

doi:10.1177/159101991201800414

Cited by 35 publications

(31 citation statements)

References 122 publications

(218 reference statements)

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“…suffering an ischemic stroke averaging an age of 54.6 years [10][11][12] . In the present study, all patients with AD had developed ischemic stroke; this could explain why our patients were older (mean 65.8 years) than those in the previous reports of patients with cervicocranial AD.…”

Section: Discussionmentioning

confidence: 99%

Posterior Circulation Ischemic Stroke Caused by Arterial Dissection: Characteristics and Predictors of Poor Outcomes

Chang¹,

Yong

Huang

et al. 2015

Cerebrovasc Dis

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Background: Posterior circulation ischemic stroke (PCS) caused by arterial dissection (AD-PCS) was rarely discussed. The present study aimed to evaluate the clinical characteristics and predictors of poor outcomes in AD-PCS patients. Methods: A total of 286 PCS patients were recruited from Taipei Veterans General Hospital Stroke Registry (between January 1, 2012 and February 28, 2014). Clinical/image data of recruited PCS patients were reviewed by stroke specialists who reached a consensus on the stroke etiologies. Data of AD-PCS patients were analyzed. Results: Seventy-four patients (65.8 ± 15.6 years, 56 (75.7%) men) were determined as AD-PCS. Headache and neck pain at admission were only presented in 18.9 and 6.8% of patients, respectively. The location of AD was initiated in the vertebral artery (66.2%), basilar artery (27.0%), posterior inferior cerebellar artery (5.4%) and posterior cerebral artery (1.4%). The involvement of intracranial arteries was present in the majority of patients (97.3%). Of the patients, 9.5% died, and 29.7% had poor functional outcomes (modified Rankin Scale ≥4) at 3-month. Conscious change independently predicted mortality at 3 months. Quadriparesis, National Institutes of Health Stroke Scale (NIHSS) score >8 and infarct lesions involving >1 category were independent predictors for poor functional outcomes at 3 months. Conclusion: AD is an important etiology of PCS. Physicians should be more vigilant in recognizing AD-PCS. Intracranial arteries are more important in AD-PCS; very few patients of AD-PCS had dissection solely in extracranial arteries. Short-term outcomes of AD-PCS were not favorable. Conscious change, quadriparesis, NIHSS score >8 and infarct lesions involving >1 category were independent predictors for poor outcomes. Patients presenting these factors should be monitored closely.

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Section: Discussionmentioning

confidence: 99%

Posterior Circulation Ischemic Stroke Caused by Arterial Dissection: Characteristics and Predictors of Poor Outcomes

Chang¹,

Yong

Huang

et al. 2015

Cerebrovasc Dis

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“…These ischemic lesions may occur due to a partial or total occlusion of the vertebral artery caused by an intraluminal or intramural thrombus, as well as the occlusion of a branch or end artery through the distal embolization of an intraluminal thrombus. 7 A minority of cases (such as 10%) are asymptomatic and are detected incidentally. 8 However, in most instances, the dissection is symptomatic and most commonly presents with head and/or neck pain, vertigo, nystagmus, vomiting, nausea, tinnitus, diplopia, hearing loss, dysesthesia, and dysphagia.…”

Section: Discussionmentioning

confidence: 99%

“…8 Although invasive catheter angiography is the gold standard in the diagnosis, noninvasive techniques such as transcranial Doppler, standard MRI, MR angiography, and CT angiography are also used. 7 Due to the dynamic nature of the dissection and the possible risks of invasive angiography, noninvasive imaging techniques are mostly preferred in children. The MRI findings characteristic of dissection are the presence of an intramural hematoma and reduction in arterial diameter.…”

Section: Discussionmentioning

confidence: 99%

Vertebral Artery Dissection Caused by Neck Tics

et al. 2018

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Vertebral arterial dissection (VAD) is a rarely observed cause of vertebrobasilar ischemia. It is often reported as individual case reports in children, and the underlying cause is usually congenital anomalies or trauma to the neck. In this case report, we present a pediatric case of VAD whose magnetic resonance (MR) and computed tomography angiographies were normal and could only be diagnosed after a careful reassessment of the initial brain MRIs considering the dynamic nature of the dissection process. Etiological investigations pointed to the patient's neck tics as the origin of the condition, which is a rare and interesting cause different from the previously reported cases in the literature. Due to the ischemic lesions in the brain stem and the cerebellum, low molecular weight heparin treatment was started and the neurological symptoms rapidly receded. Since a severe tic disorder involving the face and neck has been observed as a rare cause of VAD aside from the previously reported causes such as the Bow–Hunter syndrome reported in archers, congenital cervical anomalies, traumatic mechanical accidents, and cervical chiropractical maneuvers, the sharing of this case will contribute to the literature.

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“…The incidence rate of VADA is relatively low and the annual incidence rate has been reported to be 1/100,000 cases in the USA and 1.5/100,000 cases in France ( 10 – 12 ). VADA is common in adults, particularly those aged 40–50 years.…”

Section: Discussionmentioning

confidence: 99%

“…The onset manifestation is SAH or cerebral ischaemia. SAH usually occurs in patients with intracranial aneurysm whereas ischaemic attack occurs in patients with extracranial aneurysms ( 12 , 13 ). A local mass effect with a giant aneurysm has also been detected.…”

Section: Discussionmentioning

confidence: 99%

Endovascular interventional therapy and classification of vertebral artery dissecting aneurysms

Wang

Zhao

Hao

et al. 2014

Experimental and Therapeutic Medicine

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The current study aimed to summarise the clinical features and classifications of vertebral artery dissecting aneurysms (VADAs) to optimise strategies for endovascular interventional therapy. The clinical features and results of 31 inpatients with VADA were retrospectively analysed. The aneurysms were classified according to their location and association between the aneurysm and posterior inferior cerebellar artery (PICA), and into subtypes according to the developmental state of the contralateral vertebral artery. Different endovascular interventional therapy strategies were selected for each classification. Three types of aneurysm with two subtypes each were identified. An aneurysm located distally to the PICA was termed type I (10/31 patients). Aneurysms with a contralateral vertebral artery were denoted as subtype a (type Ia, 6/31 patients) and aneurysms with hypoplasia of the contralateral vertebral artery were denoted as subtype b (type Ib, 4/31 patients). An aneurysm located at the origin of the PICA was termed type II (13/31 patients), with seven cases classified as IIa and six cases as IIb. An aneurysm located proximally to the PICA was termed type III (8/31 patients), with five cases classified as IIIa and three cases as IIIb. Among the 31 patients, 18 received stent-assisted coiling, two received coiling, 10 received coiling with parent artery occlusion and one patient received conservative treatment. Among the 31 patients with VADA, 21 were occluded completely, nine were partially occluded and one was not occluded. One patient developed a coma following coiling; however, the other 30 patients recovered well. Thus, the classification of an aneurysm based on its location and the developmental state of the contralateral vertebral arteries appears to be an effective and safe approach for the selection of appropriate endovascular interventional therapy strategies.

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Intracranial Vertebral Artery Dissections: Evolving Perspectives

Cited by 35 publications

References 122 publications

Posterior Circulation Ischemic Stroke Caused by Arterial Dissection: Characteristics and Predictors of Poor Outcomes

Posterior Circulation Ischemic Stroke Caused by Arterial Dissection: Characteristics and Predictors of Poor Outcomes

Vertebral Artery Dissection Caused by Neck Tics

Endovascular interventional therapy and classification of vertebral artery dissecting aneurysms

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