Outcome of extracranial cervicocephalic arterial dissections

A follow-up study

F. Gonzales-Portillo, Askiel Bruno, J. Biller

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Cervicocephalic arterial dissections (CCAD) are an increasingly recognized cause of ischemic stroke in young adults. Various treatments have been suggested but no controlled trial has ever been performed. Medical treatment has included anticoagulant or platelet antiaggregant therapy. Surgical correction has been proposed for selected patients who have failed medical therapy. Percutaneous balloon angioplasty and stenting have been increasingly used in some patients, although long-term results are unknown. The objective of the study was to review our recent experience with the management and outcome of extracranial CCAD. We identified 27 patients with extracranial CCAD who were evaluated, treated and/or followed by our Stroke Service from September 1995 to August 2001. Clinical presentation, diagnostic evaluation, management, and outcome were reviewed. There were 15 men (56%) and 12 women (44%) with mean ages of 38 and 43 years respectively. Diagnosis was made by cerebral angiography in 15 (56%) patients and by MRI/MRA only in 12 (44%) patients. Twenty-two patients had spontaneous and five had traumatic extracranial CCAD. Most common associated disorders were arterial hypertension (37%) and migraine (26%). One patient presented only with a painful post-ganglionic Horner syndrome, another patient with neck pain and post-ganglionic Homer syndrome, another patient solely with protracted unilateral headaches, three with transient ischemic attacks (TIA), and 21 with ischemic strokes. The internal carotid artery (ICA) was the most frequently involved vessel (63%), followed by the vertebral artery (30%), and multivessel involvement in two patients (7%). Eighteen patients received anticoagulant therapy and nine platelet anti-aggregants. Follow-up extended from 2 to 115 months, with a mean of 58 months. At the end of follow-up, 23 (85%) patients had either no disability or only minor sequelae (modified Rankin score: 0 to 1), and four (15%) patients had moderate limitations (modified Rankin score: 2 to 3). Two patients had a recurrent ischemic stroke, one unrelated to recurrent CCAD, and the other following percutaneous balloon angioplasty/stenting for treatment of a persistent vertebral artery pseudoaneurysm. Most CCAD involved the extracranial ICA. The clinical presentation is variable, most patients having an ischemic stroke or TIAs. The short- and long-term outcome are usually favorable with either anticoagulant or platelet antiaggregant therapy. A medical initial approach to the management of extracranial CCAD is recommended for most patients.

Original languageEnglish (US)
Pages (from-to)395-398
Number of pages4
JournalNeurological Research
Volume24
Issue number4
DOIs
StatePublished - Jun 24 2002

Fingerprint

Dissection
Stroke
Anticoagulants
Balloon Angioplasty
Vertebral Artery
Platelet Aggregation Inhibitors
Internal Carotid Artery
Therapeutics
Horner Syndrome
Cerebral Angiography
Neck Pain
False Aneurysm
Transient Ischemic Attack
Migraine Disorders
Headache
Young Adult
Blood Platelets

Keywords

  • Cervicocephalic arterial dissections
  • Clinical evaluation
  • Early diagnosis
  • Ischemic stroke

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Outcome of extracranial cervicocephalic arterial dissections : A follow-up study. / Gonzales-Portillo, F.; Bruno, Askiel; Biller, J.

In: Neurological Research, Vol. 24, No. 4, 24.06.2002, p. 395-398.

Research output: Contribution to journalArticle

Gonzales-Portillo, F. ; Bruno, Askiel ; Biller, J. / Outcome of extracranial cervicocephalic arterial dissections : A follow-up study. In: Neurological Research. 2002 ; Vol. 24, No. 4. pp. 395-398.
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