Unfortunately, the vertebral arteries cannot always be satisfactorily imaged using ultrasound, and the diagnosis relies more on indirect doppler hemodynamic signs than on direct identification of the dissection 10. Recovery progress after stroke and vertebral artery dissection. Carotid and vertebral dissection imaging springerlink. Although there has been a recent increase in the number of reported cases of vertebral artery va dissection, the clinical variety of presentation and the early warning symptoms have not been welldescribed before. Carotid and vertebral dissection imaging request pdf. Followup imaging of traumatic vertebral artery dissections is unnecessary in asymptomatic patients. Presented in the poster competition at the 2018 vascular annual meeting of the society for vascular surgery, boston, mass, june 2023, 2018. The imaging findings of acute vertebral artery dissection vad are well known. Vertebral artery dissection an overview sciencedirect. I have been meaning to provide an update on my recovery progress after suffering the vertebral artery dissection and stroke.
Vertebral artery dissection is a potential cause of posterior circulation ischemia that requires highspatialresolution imaging for the definitive diagnosis. Ct angiography provides better spatial resolution than mr imaging to evaluate the caliber of a severely narrowed vessel fig. The diagnostic modalities that are used to image the carotid artery diseases are digital subtraction angiography dsa, duplex ultrasound dus, computed. A suspected arterial dissection can be diagnosed using magnetic resonance imaging mri, magnetic resonance angiography mra. Imaging of cervical artery dissection sciencedirect. Cad is involved in nearly 2% of all cerebrovascular accidents in the general population and nearly 20% of cva in patients over 45 years of age. Vertebral artery dissection radiology reference article. Statistical analysis was performed with spss 10 for macintosh statistical software spss inc. If the dissection is subintimal, the expanding hematoma may partially or completely occlude the vertebral artery or one of its branches. Spontaneous intracranial vertebrobasilar dissection vbd can manifest with various clinical symptoms, including subarachnoid hemorrhage, ischemic symptoms from impaired posterior circulation, or even local symptoms most commonly headache, in young adults 1, 2. Accurate diagnosis of scad through use of imaging is critical, as emerging evidence suggests that the optimal short and longterm management.
Results one hundred sixtynine patients with 195 svad were identified. Vertebral artery dissection vad is a rare condition that occurs when a tear in the artery wall allows blood to leak between the walls layers and separate them. In the study of carotid arteries, the different imaging techniques allow to analyze various diseases like stenoses, aneurysms, thromboses, dissections, diseases caused by atherosclerotic plaques or congenital abnormalities. Antiplatelet therapy vs anticoagulation in cervical artery.
Spontaneous symptomatic intracranial vertebrobasilar. Included as part of the 4 credits, this cme activity is eligible for 4 stroke cme, 4 trauma cme, and 1 pharmacology cme credits. Recent advancements in cardiac imaging have improved identification and accelerated awareness of scad. If the patient had experienced stroke or transient ischemic attack tia within the last 7 days, they were eligible even if this was preceded by local.
Cervical carotid or vertebral artery dissection diagnosis and. Recently, va dissection has become increasingly recognized as a source of stroke and subarachnoid hemorrhage sah. We sought to summarize the diagnostic value of various imaging findings in patients with symptomatic vad. Highresolution double inversion recovery blackblood imaging of cervical artery dissection using 3t mr imaging m. The diagnosis of vertebral artery dissection is complicated by a lack of specific imaging requirements. Dissection is believed to occur secondary to a sudden. When the vessel wall is torn, blood pools inside the artery and begins to clot. Dissection of the right v2 vertebral artery with subacute intramural hematoma. Another problem with diagnosis of vertebral artery dissection is the common exclusion of v1 from the imaged volume, 43.
It offered excellent visualization of both the lumen and arterial wall, allowing detection of the primary and secondary features of dissection. Vertebral artery dissection vad is an important cause of stroke in the young. Imaging characteristics of vertebral artery dissection. Introduction vertebral artery dissection vad is often a clinically elusive diagnosis, given a range of presentations depending on the presence or absence of precipitating factors, often nonspecific clinical symptoms, and varied symptomatology depending on where along the vertebral artery a dissection occurs. The inside of the artery is covered with a thin layer of cells called intima it is like a skin for the inside of the artery. Spontaneous dissection of the vertebral artery svad is a potentially.
Imaging characteristics of symptomatic vertebral artery. Because most hemodynamically significant lesions of the vertebral arteries occur at their origin region v1, defined as the segment from the origin of the vertebral artery to its entrance into the foramen of the transverse process, which occurs at the level of the sixth cervical vertebra in approximately 90% of cases, it would seem that this. Dissection of the internal carotid artery or the vertebral artery va causes only 0. Although conventional intraarterial digital subtraction angiography remains the gold standard method for imaging the vertebral artery, noninvasive modalities such as ultrasound, multislice computed tomographic angiography and magnetic resonance angiography are constantly improving and are playing an increasingly important role in diagnosing vertebral. Statistical analyses were performed using jmp software, version 10 sas. Imaging in carotid and vertebral artery dissection.
Cervical artery dissection cad is an increasingly commonly identified cause of cerebrovascular accidents. Accurate diagnosis of scad through use of imaging is critical, as emerging evidence. Antiplatelet drugs, cerebrovascular disease, dissection, magnetic resonance imaging, vertebrobasilar disease neurosurgery 69. Cad are defined as the presence of a mural haematoma in the wall of an artery leading into the intracranial space. Cervical carotid or vertebral artery dissection cleveland clinic. A vertebral artery dissection vad is a tear in the wall of a major artery leading to the intrusion of blood within the layers of an arterial wall intramural hematoma. Arterial dissection carotid, vertebral, basilar arteries.
Imaging of carotid artery dissection pubmed central pmc. Spontaneous coronary artery dissection scad has gained attention as a key cause of acute coronary syndrome and sudden cardiac death among women. Vertebral artery dissection vad is often a clinically elusive diagnosis, given a range of presentations depending on the presence or absence of precipitating factors, often nonspecific clinical symptoms, and varied symptomatology depending on where along the vertebral artery a dissection occurs. Cad is the leading cause of ischemic stroke in patients younger than 45 years. It arises from the distal cervical internal carotid artery usually between the c1 and c3 vertebral bodies, passes through an enlarged hypoglossal canal, and joins the proximal basilar artery figs.
Resultsone hundred sixtynine patients with 195 svad were identified. Inclusion criteria were extracranial carotid or vertebral artery dissection with symptom onset within the last 7 days, in combination with imaging evidence of definite or probable dissection. To accurately diagnose this condition, the doctor can choose from several different imaging technologies to see how well blood is flowing through. Vertebral artery dissection with a normalappearing lumen. We performed highresolution dirbbi of the cervical arteries at 3t in 19 subjects with cervical dissection. Vessel wall imaging of the intracranial and cervical. Forbes american journal of neuroradiology dec 2012, 33 11 e3e7. Imaging of the pathology of the vertebral arteries. Cervical artery dissection cad may affect the internal carotid andor the vertebral arteries.
Arterial dissection can cause a droopy eye lid with a small pupil on the same side, headache, neck pain, or stroke symptoms. Arteries are like laminated tubes, their walls composed of many tissue layers, such as muscle, connective tissue, etc. Cervical artery dissection cad is an important cause of stroke for young patients, accounting for 522% of strokes in patients dissections. Methodsclinical characteristics, imaging findings, 3month outcomes, and its predictors were investigated in consecutive patients with svad. Request pdf carotid and vertebral dissection imaging carotid or vertebral artery dissection is the result of a tear in the vessel lining wherein the intima separates the media. Conventional angiography has long been considered the gold standard for imaging of vertebral artery dissections. T he primary presentation of an unruptured intracranial vertebral artery va dissection is severe occipital headache only or. Causes of misinterpretation of crosssectional imaging. Fused images aided distinction between vertebral artery dissection versus. This creates a false or pseudo lumen, often accompanied by hemorrhage into the arterial wall. Multimodality imaging for spontaneous coronary artery.
Digital subtraction angiography dsa remains the gold standard for assessment of the vertebrobasilar arteries, with excellent spatial and temporal resolution 2, 3. Arterial dissection is a tear of the inside of the artery. Patients may relate their symptoms to turning or extending their heads. There are two vertebral arteries in the human body, located in the back of the neck near the spine. Typically, a magnetic resonance imaging mri and mr angiogram are done to look at the brain and the blood vessels of the head and neck and visualize a tear within the wall of an artery. Methods clinical characteristics, imaging findings, 3month outcomes, and its predictors were investigated in consecutive patients with svad.
We suggest that this is a highly useful technique for diagnosis of cervical dissection, either routinely or in. Highresolution double inversion recovery blackblood. Internal carotid artery dissection has been extensively studied and welldescribed. Improvement and aggravation of spontaneous unruptured vertebral. Extensive dissections those that extend intracranially and involve the basilar artery result in infarctions of the brainstem, cerebellum or. Specific treatment aspirin or anticoagulants can be implemented once the diagnosis of cad has been confirmed. Vertebral artery dissection, like arterial dissection elsewhere, is a result of blood entering the media through a tear in the intima. Background and purpose few data exist about clinical, radiologic findings, clinical outcome, and its predictors in patients with spontaneous vertebral artery dissection svad. Reviews advanced screening criteria and imaging for patients with cervical artery dissections, and antithrombotic treatment strategies to reduce ischemic stroke.
I had another mra magnetic resonance angiogram scan of my head and neck vasculature on january 30th, about eight weeks after the stroke and six weeks after beginning the anticoagulant therapy. Dissection of the craniocervical arteries is a diagnosis that can be very difficult on crosssectional imaging studies such as ct angiography, mri, and mr angiography. Details of the image vertebral artery dissection modality. This study assessed the diagnostic value of various imaging findings in symptomatic vad. It can occur in either of the two branches of these neck arteries as a result of trauma, or can arise spontaneously as a consequence of connective tissue disease. Dissection of these craniocervical vessels often manifests with pain alone but, if untreated, may result in severe neurologic compromise. The diagnosis of reversal of vertebral artery flow can be made accurately by noninvasive indirect methods and demonstrated directly by duplex imaging of the reversal of flow in the vertebral artery. The persistent hypoglossal artery is the second most common carotidvertebrobasilar variant, present in 0.
Carotid or vertebral artery dissection is the result of a tear in the vessel lining wherein the intima separates the media. Firstline treatment for cervical artery dissection usually is antiplatelet. A short dissection can be missed if there are gaps between the imaging slabs. They, along with the carotid arteries, supply blood to the brain. Internal carotid artery dissection often begins beyond the vessel origin, unlike most atherosclerotic.
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