Recanalization of Vertebral Artery Dissection

Araúz, Antonio; Márquez, Juan; Artigas, Carol; Balderrama, Jorge; Orrego, H

doi:10.1161/strokeaha.109.568790

Cited by 53 publications

(48 citation statements)

References 20 publications

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“…Case series comment that recanalization often occurs within the first 6 months or earlier, 1,215,220 that 82% of healing occurs within the first year with a median time to healing of 3 to 4 months, 8 and that median time until near or total recanalization was 4.7 months. 2 Again, no reports commented on any association with CMT.…”

Section: Follow-up Of Dissected Arteriesmentioning

confidence: 99%

“…In general, the majority of patients with strokes caused by CDs have good outcomes, with rates that vary from 70% to 92%. 8,59,98,160,[215][216][217][218][219][220] Even a small series of 12 cases with 3 or 4 simultaneous dissections on initial diagnosis from 3 European centers showed excellent outcomes (mRS score=0-1) in 83%. 221 Associations with better outcomes include ICAD that had shown recanalization 215 and lesser initial stroke severity.…”

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confidence: 99%

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Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

179

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3155Purpose-Cervical artery dissections (CDs) are among the most common causes of stroke in young and middle-aged adults.The aim of this scientific statement is to review the current state of evidence on the diagnosis and management of CDs and their statistical association with cervical manipulative therapy (CMT). In some forms of CMT, a high or low amplitude thrust is applied to the cervical spine by a healthcare professional. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. Results-Patients with CD may present with unilateral headaches, posterior cervical pain, or cerebral or retinal ischemia (transient ischemic or strokes) attributable mainly to artery-artery embolism, CD cranial nerve palsies, oculosympathetic palsy, or pulsatile tinnitus. Diagnosis of CD depends on a thorough history, physical examination, and targeted ancillary investigations. Although the role of trivial trauma is debatable, mechanical forces can lead to intimal injuries of the vertebral arteries and internal carotid arteries and result in CD. Disability levels vary among CD patients with many having good outcomes, but serious neurological sequelae can occur. No evidence-based guidelines are currently available to endorse best management strategies for CDs. Antiplatelet and anticoagulant treatments are both used for prevention of local thrombus and secondary embolism. Case-control and other articles have suggested an epidemiologic association between CD, particularly vertebral artery dissection, and CMT. It is unclear whether this is due to lack of recognition of preexisting CD in these patients or due to trauma caused by CMT. Ultrasonography, computed tomographic angiography, and magnetic resonance imaging with magnetic resonance angiography are useful in the diagnosis of CD. Follow-up neuroimaging is preferentially done with noninvasive modalities, but we suggest that no single test should be seen as the gold standard.

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Section: Follow-up Of Dissected Arteriesmentioning

confidence: 99%

mentioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

179

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“…The mean age of our patients was younger (55.8 years) than in most series (≥60 years-old); this is probably the result of a referral bias to a tertiary-level stroke facility, with higher frequency of spontaneous cerebral vessel dissections [30,31], cardiac valvular lesions from rheumatic fever, CVTs, and other infrequent pathologies. Also, a high frequency (59%) of left-sided ischemic lesions increases VaD risk 5-fold (OR 5.0; 95% CI 1.92-14.1) [32].…”

Section: Discussionmentioning

confidence: 78%

Vascular Cognitive Disorders and Depression After First-Ever Stroke: The Fogarty-Mexico Stroke Cohort

et al. 2014

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Background and Purpose: Stroke is the major cause of vascular behavior and cognitive disorders worldwide.In developing countries, there is a dearth of information regarding the public health magnitude of stroke. The aim of the Fogarty-Mexico cohort was to assess the prevalence of vascular behavioral and cognitive disorders, ranging from mild vascular cognitive impairment (VCI) to vascular dementia (VaD), in a cohort of acute first-ever symptomatic stroke patients in Mexico. Methods: A total of165 consecutive, first-ever stroke patients admitted to the National Institute of Neurology and Neurosurgery in Mexico City, were included in the cohort. Patients were eligible if they had an ischemic stroke, primary intracerebral hemorrhage, or cerebral venous thrombosis (CVT). Stroke diagnosis required the presence of an acute focal deficit lasting more than 24 h, confirmed by a corresponding lesion on CT/MRI. Stroke severity was established with the NIH Stroke Scale. The pre-stroke functional status was determined by the IQCODE. Three months after the occurrence of stroke, 110 survivor patients returned for follow-up and were able to undergo functional outcome (modified Rankin scale, Barthel index), along with neurological, psychiatric, neuropsychological, laboratory, and imaging assessments. We compared depression, demographic, and clinical and imaging features between patients with and without dementia, and between patients with VCI and those with intact cognition. Results: Of the 110 patients (62% men, mean age 56 ± 17.8, education 7.7 ± 5.2 years) 93 (84%) had ischemic strokes, 14 (13%) intracerebral hemorrhage, and 3 (3%) CVT. The main risk factors were hypertension (50%), smoking (40%), hypercholesterolemia (29%), hyperhomocysteinemia (24%), and diabetes (22%). Clinical and neuropsychological evaluations demonstrated post-stroke depression in 56%, VCI in 41%, and VaD in 12%; 17% of the latter had pre-stroke functional impairment (IQCODE >3.5). Cognitive deficits included executive function in 69%, verbal memory in 49%, language in 38%, perception in 36%, and attention in 38%. Executive dysfunction occurred in 36% of non-demented subjects, 65% of them with mild-moderate deficits in daily living activities. Female gender (p ≤ 0.054), older age (mean age 65.6 years vs. 49.3, p < 0.001), diabetes (p ≤ 0.004), illiteracy and lower education (p ≤ 0.001), and PSD (p = 0.03) were significantly higher in VCI-VaD compared with cognitively intact post-stroke subjects. We could not demonstrate an association with lesion site and distribution of the cognitive deficits. Conclusions: The Fogarty-Mexico cohort recruited relatively young acute stroke patients, compared with other Mexican stroke cohorts. PSD and VCI occurred frequently but prevalence of VaD (12%) was lower than expected. A high prevalence of treatable stroke risk factors suggests that preventive interventions are advisable.

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“…Similarly, we arbitrarily chose to consider patients with unchanged VA occlusion as non-VAD patients. A longer monitoring period might have shown late recanalization, though Arauz et al 24 recently demonstrated that recanalization of VAD occurs mainly within the first 6 months after the onset of symptoms, even in the case of occlusion. Finally, in the case of multiple VADs (2 patients), we chose to consider only the symptomatic VAD, given that the treatment does not depend on the number of dissected vessels, and to avoid an artificial increase in the population.…”

Section: Discussionmentioning

confidence: 99%

Added Value of High-Resolution MR Imaging in the Diagnosis of Vertebral Artery Dissection

Naggara¹,

Louillet²,

Touzé³

et al. 2010

AJNR Am J Neuroradiol

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BACKROUND AND PURPOSE:The optimal imaging method for the diagnosis of VAD remains undefined. Our aim was to evaluate the added value of HR-MR imaging for the diagnosis of VAD. MATERIALS AND METHODS:We retrospectively extracted 35 consecutive patients suspected of having acute VAD who had the following: 1) a focal lumen abnormality of the VA on CE-MRA, 2) HR-MR imaging during the initial hospital stay, and 3) clinical and imaging follow-up within 6 months. Two neurologists classified patients as either VAD (group A) or non-VAD (group B) by reviewing all the available data at hospital discharge, except HR-MR imaging data. On HR-MR imaging, 2 radiologists searched for signs of acute VAD. The 2 classifications were compared. In case of discordance, CE-MRA follow-up and axial fat-suppressed T1WI, used to obtain supportive evidence for or against VAD, were considered as the standard of reference. RESULTS:In 4/18 patients in group A, HR-MR imaging did not demonstrate any signs of acute VAD and perivertebral signal-intensity changes were attributed to venous plexus, with an unchanged lumen on follow-up. In 4/17 patients in group B, HR-MRI demonstrated a mural hematoma, with lumen normalization on follow-up CE-MRA. CONCLUSIONS:Our results encourage the use of HR-MR imaging as a second-line diagnostic tool in the event of suspicion of acute VAD and doubtful findings on standard imaging.ABBREVIATIONS: CE-MRA ϭ contrast-enhanced MR angiography; CI ϭ confidence interval; DSA ϭ digital subtraction angiography; DUS ϭ Doppler ultrasonography examination; DWI ϭ diffusionweighted imaging; HR ϭ high resolution; NIHSS ϭ National Institutes of Health Stroke Scale; PDWI ϭ proton attenuationϪweighted imaging; T1WI ϭ T1-weighted imaging; T2WI ϭ T2-weighted imaging; TE eff ϭ effective echo-time; TOF ϭ time of flight; V2 and V3 ϭ the second and third VA segments; VA ϭ vertebral artery; VAD ϭ VA dissection

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Recanalization of Vertebral Artery Dissection

Cited by 53 publications

References 20 publications

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Vascular Cognitive Disorders and Depression After First-Ever Stroke: The Fogarty-Mexico Stroke Cohort

Added Value of High-Resolution MR Imaging in the Diagnosis of Vertebral Artery Dissection

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