Efficacy of high-resolution cone-beam CT in the evaluation of perforators in vertebral artery dissection

Introduction A major complication of internal coil trapping for vertebral artery dissection (VAD) is medullary infarction associated with perforator occlusion. Currently, higher spatial resolution imaging can be obtained with high-resolution cone-beam computed tomography (VASO CT), and the efficacy of perforator visualization adjacent to VAD was examined. Methods Eight patients who underwent internal coil trapping or stent-supported coil embolization underwent VASO CT to evaluate perforators around VAD. Visualization of perforators was compared with conventional digital subtraction angiography (DSA) and three-dimensional rotational angiography (3D-RA). Postoperative MRI was performed in all patients to investigate ischemic complications. The relationship between the perforators and the infarction was analyzed. Results Perforator visualization was much clearer on VASO CT than on 2D DSA or 3D-RA. It was sharp enough to identify each perforating artery. Medullary infarctions were detected in two cases. In these two cases, each ischemic lesion corresponded to the territory of a perforator that was well visualized on VASO CT. The axial view with adjoining tissue structures on VASO CT was useful to detect the territories of perforators. Conclusions VASO CT is an efficient modality for the detection and identification of perforators in the vicinity of VAD. It provides accurate anatomical information about the vertebrobasilar system that is useful for the treatment of unruptured VAD.

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Utility of cone-beam computed tomography angiography for the assessment of vertebral artery dissection

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2017.11.010 ◽

2018 ◽

Vol 48 ◽

pp. 76-80 ◽

Cited By ~ 2

Author(s):

Kenji Fukuda ◽

Toshio Higashi ◽

Masakazu Okawa ◽

Juntaro Matsumoto ◽

Koichi Takano ◽

...

Keyword(s):

Computed Tomography ◽

Vertebral Artery ◽

Cone Beam Computed Tomography ◽

Computed Tomography Angiography ◽

Vertebral Artery Dissection ◽

Cone Beam ◽

Artery Dissection

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Abstract TP84: Prognostic Factor of Intracranial Vertebral Artery Dissection: High Resolution Vessel Wall Magnetic Resonance Imaging Study

Stroke ◽

10.1161/str.51.suppl_1.tp84 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Jae-Hwan Kim ◽

Hyung Jun Kim ◽

Ye Sel Kim ◽

Woo-Keun Seo ◽

Oh Young Bang ◽

...

Keyword(s):

Ischemic Stroke ◽

High Resolution ◽

Prognostic Factor ◽

Vertebral Artery ◽

Vessel Wall ◽

Independent Predictor ◽

Vertebral Artery Dissection ◽

Posterior Circulation ◽

Artery Dissection ◽

Poor Outcomes

Background: Vertebral artery dissection (VAD) is well recognized cause of stroke in young and middle aged individuals. But, prognostic factor of posterior circulation ischemic stroke or transient ischemic attack (TIA) caused by intracranial VAD has been rarely discussed. Our aim was to evaluate the predictors of poor outcomes in posterior circulation ischemic stroke caused by intracranial VAD. Methods: We retrospectively reviewed patients with posterior circulation ischemic stroke or TIA caused by intracranial VAD using high-resolution vessel wall MRI who were recruited from Samsung Medical Center Stroke Registry (between January 1, 2011 and April 30, 2019). Poor outcomes were defined as a 3-months modified Rankin scale (mRS) score ≥ 2. Results: We registered 96 patients (74 males; mean age, 58.9±14.2 years) with acute posterior circulation ischemic stroke or TIA caused by intracranial VAD. Trauma history associated with VAD was presented in 23 (24%) of patients. Headache and neck pain around neurological symptom onset were presented in 41 (42.7%) and 19 (19.8%) of patients, respectively. Dissecting aneurysm, bilateral vertebral artery involvement, basilar artery involvement and wall hematoma with dissection were presented in 26 (27.1%), 26 (27.1%), 12 (12.5%) and 66 (68.8%) of patients, respectively. Of the 96 VADs, 26 (27.1%) presented with focal stenosis, 21 (21.9%) with multifocal stenosis, and 57 (59.4%) with occlusion. Lateral medulla involvement and multiple territory involvement were presented in 35 (36.5%) and 31 (32.3%) of patients. Recurrence rate of ischemic stroke or TIA within 90 days of symptom onset was 6.25%. Twenty-nine patients (30.2%) had poor outcomes at 3 months. Lateral medulla involvement was an independent predictor for poor outcome (odds ratio=3.293, 95% confidence interval=1.301-8.333, p=0.012). Conclusion: Posterior circulation ischemic stroke or TIA caused by intracranial VAD is associated with relatively benign clinical course. But the presence of lateral medulla involvement is independent predictor for poor outcome. Patients presenting lateral medullary infarction caused by intracranial VAD should be monitored closely.

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Spontaneous Intracranial Vertebral Artery Dissection in a 2-Year-Old Child Diagnosed with High-Resolution MRI: a Case Report

Investigative Magnetic Resonance Imaging ◽

10.13104/imri.2019.23.3.259 ◽

2019 ◽

Vol 23 (3) ◽

pp. 259

Author(s):

Subin Heo ◽

Miran Han ◽

Sung Hwan Kim ◽

Jin Wook Choi

Keyword(s):

Case Report ◽

High Resolution ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

High Resolution Mri

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Selective Application of High-Resolution 3 T MRI in the Evaluation of Intracranial Vertebral Artery Dissection

Journal of Neuroimaging ◽

10.1111/jon.12368 ◽

2016 ◽

Vol 27 (1) ◽

pp. 71-77 ◽

Cited By ~ 3

Author(s):

Jaechun Hwang ◽

Jong-Won Chung ◽

Jihoon Cha ◽

Oh Young Bang ◽

Chin-Sang Chung ◽

...

Keyword(s):

High Resolution ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection

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Asymptomatic spontaneous acute vertebral artery dissection: diagnosis by high-resolution magnetic resonance images with a dedicated surface coil

European Radiology ◽

10.1007/s00330-006-0524-7 ◽

2007 ◽

Vol 17 (9) ◽

pp. 2434-2435 ◽

Cited By ~ 16

Author(s):

Olivier Naggara ◽

Catherine Oppenheim ◽

Jean Francois Toussaint ◽

David Calvet ◽

Emmanuel Touze ◽

...

Keyword(s):

Magnetic Resonance ◽

High Resolution ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Surface Coil ◽

Magnetic Resonance Images ◽

Artery Dissection

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Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature

Journal of Medical Case Reports ◽

10.1186/s13256-021-03090-z ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Francesca Monari ◽

Stefano Busani ◽

Maria Giovanna Imbrogno ◽

Isabella Neri ◽

Massimo Girardis ◽

...

Keyword(s):

Differential Diagnosis ◽

Cervical Spine ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Caucasian Woman ◽

Ischemic Lesion ◽

History Of ◽

Cervical Spine Manipulation ◽

In Pregnancy

Abstract Background Vertebral artery dissection is an uncommon, but potentially fatal, vascular event. This case aimed to describe the pathogenesis and clinical presentation of vertebral artery dissection in a term pregnant patient. Moreover, we focused on the differential diagnosis, reviewing the available evidence. Case presentation A 39-year-old Caucasian woman presented at 38 + 4 weeks of gestation with a short-term history of vertigo, nausea, and vomiting. Symptoms appeared a few days after cervical spine manipulation by an osteopathic specialist. Urgent magnetic resonance imaging of the head was obtained and revealed an ischemic lesion of the right posterolateral portion of the brain bulb. A subsequent computed tomography angiographic scan of the head and neck showed a right vertebral artery dissection. Based on the correlation of the neurological manifestations and imaging findings, a diagnosis of vertebral artery dissection was established. The patient started low-dose acetylsalicylic acid and prophylactic enoxaparin following an urgent cesarean section. Conclusion Vertebral artery dissection is a rare but potential cause of neurologic impairments in pregnancy and during the postpartum period. It should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women with a history of migraines, hypertension, or autoimmune disorders in pregnancy are at higher risk, as well as following cervical spine manipulations. Prompt diagnosis and management of vertebral artery dissection are essential to ensure favorable outcomes.

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

American Journal of Neuroradiology ◽

10.3174/ajnr.a2165 ◽

2010 ◽

Vol 31 (9) ◽

pp. 1707-1712 ◽

Cited By ~ 38

Author(s):

O. Naggara ◽

F. Louillet ◽

E. Touzé ◽

D. Roy ◽

X. Leclerc ◽

...

Keyword(s):

High Resolution ◽

Mr Imaging ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Added Value ◽

Artery Dissection

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Vertebral artery dissection stroke in evolution presented with postural headache as initial manifestation

Neurology International ◽

10.4081/ni.2018.7694 ◽

2018 ◽

Vol 10 (2) ◽

Author(s):

Yen-Chung Chen ◽

Yang-Hao Ou ◽

Ming-Che Chang ◽

Wei-Liang Chen ◽

Chih-Ming Lin

Keyword(s):

Vertebral Artery ◽

Brain Mri ◽

Vertebral Artery Dissection ◽

Spontaneous Intracranial Hypotension ◽

Artery Dissection ◽

Emission Computed Tomography ◽

Ischemic Lesion ◽

Postural Headache ◽

Adequate Hydration ◽

Lateral Medullary Syndrome

In young adult, the most common etiology of acute ischemic brain infarction are arterial dissections and cardiogenic embolic stroke. Vertebral artery dissection without preceding trauma history is quite rare in young ischemic stroke patients. Postural headache is even more atypical presentation for vertebral artery dissection. It is often misdiagnosed as spontaneous intracranial hypotension. We described a 37-year-old male suffering from acute onset postural headache with stroke in evolution during hospitalization. The initial brain magnetic resonance imaging (MRI) mislead to diagnosis of ischemic lesion. Nevertheless, with the aid of single photon emission computed tomography, we are confident the patient was afflicted with ischemic/hemorrhagic lesion, instead of neoplasm or demyelinating diseases. Lateral medullary syndrome was confirmed on the repeated brain MRI. His general condition improved with steady gait and clear articulation without easychoking after adequate hydration and rehabilitation training with aspirin as secondary prevention. Cranial artery dissections is a crucial differential diagnosis while thunderclap headache happens even related to postural change without obvious neurological deficit in the beginning presentations.

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