Carotid and Vertebral Artery Dissection Syndromes.

Abstract Objetives: To describe the clinical presentation, diagnosis and treatment of patients with carotid and vertebral artery dissection (CAD, VAD). Design: Retrospective, observational Patients and methods: Clinical recording were evaluated from 1996 to 2005; 6 patients (3 women, 3 men, mean age 37 years) with CAD (3) and VAD (3) were referred to our hematology unit. Clinical presentation: progressing stroke 4/6 and transient ischemic attack (TIA) 2/6; warning sings and symptoms preceding the onset of stroke in 80%. Vascular risk factors included smoking and hypertension; associated features were headache, visual symptoms and Horner’s syndrome; Predisposing factors as physical exercise and trauma were found in 4/6. One patient was at 20 weeks of pregnancy. Diagnosis: Diagnostic tests included: Doppler ultrasound, magnetic resonance imaging (MRI) and angiography (MRA). On admission angiographic studies showed occlusion or stenoses of dissected arteries. Treatment: Anticoagulation with heparin or low molecular weight heparin followed by oral anticoagulants. Outcome: No hemorrhagic complication, no recurrence, complete recovery in 5 patients and mild dysarthria in one. Conclusion: TIA and progressing stroke in young patients are presenting features of CAD and VAD. The diagnosis is based on clinical signs and confirming angiographic investigation. Our experience shows that anticoagulation is the treatment of choice, although controlled studies to show their effectiveness are lacking.

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D-Dimer As An Indicator of Vertebral Artery Dissection: A Case Control Study

10.21203/rs.3.rs-389184/v1 ◽

2021 ◽

Author(s):

Atsuyuki Watanabe ◽

Hiroshi Ito ◽

Kazushi Maruo ◽

Junzo Nakao ◽

Takako Kaino ◽

...

Keyword(s):

Blood Pressure ◽

Neck Pain ◽

Vertebral Artery ◽

Laboratory Data ◽

Vertebral Artery Dissection ◽

Young Patients ◽

Artery Dissection ◽

Diagnostic Model ◽

Common Symptom ◽

D Dimer

Abstract Background Vertebral artery dissection (VAD), which can possibly lead to stroke, presents various symptoms such as headache, neck pain, transient ischemic attacks, and vertigo. We evaluated the effect of D-dimer to distinguish VAD from benign diseases by retrospective single-center observational study. Methods All VAD cases received in the emergency department between January 2013 and June 2020 were reviewed. Comparing those cases to vertigo with benign etiologies, the correlation between VAD and D-dimer was analyzed. Using stepwise multivariate logistic regression, possible symptoms to suspect VAD were also determined from physical findings and some laboratory data, including D-dimer. Results Eleven patients were included in the VAD group, and 59 patients were enrolled in the control (benign vertigo [BV]) group. The most common symptom in VAD patients was hemiplegia (N = 7, 63.6%) and cranial neuropathy (N = 7, 63.6%), followed by classic occipital or posterior neck pain (N = 4, 36.4%), gait ataxia (N = 3, 27.3%), and confusion (N = 1, 9.1%). Two patients (18.2%) were free from any symptoms except vertigo. D-dimer was not significantly different between the two groups at the positive cutoff value of 500 ng/mL (p = 1). By stepwise selection, age (odds ratio (OR): 0.92, [0.87–0.98], p < 0.01) and systolic blood pressure (sBP; OR: 1.06 [1.02–1.10], p < 0.01) were selected in the diagnostic model. In combination, age under 60 and sBP over 160 mmHg yielded 63.6% sensitivity, 98.3% specificity, and 37.5 positive likelihood ratio. Conclusions In our study, D-dimer was not found to be an effective indicator of VAD. By contrast, disproportionate hypertension (high blood pressure in young patients) can be a key factor to suspect VAD. Future studies with larger sample sizes are warranted.

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Anticoagulation vs Antiplatelet Treatment in Patients with Carotid and Vertebral Artery Dissection: A Study of 370 Patients and Literature Review

Neurosurgery ◽

10.1093/neuros/nyw086 ◽

2017 ◽

Vol 80 (3) ◽

pp. 368-379 ◽

Cited By ~ 26

Author(s):

Badih Daou ◽

Christine Hammer ◽

Nikolaos Mouchtouris ◽

Robert M. Starke ◽

Sravanthi Koduri ◽

...

Keyword(s):

Clinical Outcome ◽

Vertebral Artery ◽

Recurrent Events ◽

Combined Treatment ◽

Vertebral Artery Dissection ◽

Young Patients ◽

Artery Dissection ◽

Antiplatelet Treatment ◽

Hemorrhagic Events

Abstract BACKGROUND: Dissection of the carotid and vertebral arteries is an important cause of stroke in young patients. OBJECTIVE: The objective of this study is to compare antithrombotic treatments in patients with carotid and vertebral dissections. METHODS: Three hundred seventy patients with carotid and vertebral artery dissections were included. Univariate and multivariate analyses were conducted to analyze the association between treatment and new or recurrent events and clinical outcome. RESULTS: Mean follow-up was 24.3 months. In patients with spontaneous dissection, 55% received antiplatelets, 29.4% anticoagulation, and 12.6% combined treatment. New or recurrent ischemic and hemorrhagic events occurred in 9.6% of patients on antiplatelets, 10.4% on anticoagulation, and 13.3% on combined treatment. For traumatic dissection, 58.3% received antiplatelets, 26.9% anticoagulation, and 10.2% combined treatment. New or recurrent ischemic and hemorrhagic events occurred in 6.9% on antiplatelets, 11.1% on anticoagulation, and 20% on combined treatment. In patients with intracranial dissection, 63.1% were started on antiplatelets, 19.7% on anticoagulation, and 14.5% on combined treatment. Ischemic and hemorrhagic events occurred in 8.5% on antiplatelet treatment, 15.4% on anticoagulation, and 18.2% on combined treatment. In patients with extracranial dissection, 54.4% were on antiplatelets, 28.9% on anticoagulation, and 11.2% on combined treatment. Ischemic and hemorrhagic events occurred in 10.1% on antiplatelet treatment, 9.3% on anticoagulation, and 13.8% on combined treatment. The association between antithrombotic treatment and ischemic/hemorrhagic events and clinical outcome was not significant for all subtypes of dissection. CONCLUSION: The rate of new or recurrent events is similar with antiplatelet and anticoagulation treatment in treating intracranial and extracranial carotid and vertebral artery dissection.

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Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection

European Neurology ◽

10.1159/000452303 ◽

2016 ◽

Vol 76 (5-6) ◽

pp. 284-294 ◽

Cited By ~ 5

Author(s):

Albrecht Günther ◽

Otto W. Witte ◽

Martin Freesmeyer ◽

Robert Drescher

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Vertebral Artery ◽

Clinical Presentation ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Ultrasound Findings

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Dissecting spontaneous vertebral artery aneurysms (V4). Endovascular Reconstructive techniques with fd stents. Case series

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v31i4.1896 ◽

2020 ◽

Vol 31 (4) ◽

pp. 305-313

Author(s):

João Victor Amaro de Souza ◽

Guilherme Cabral de Andrade ◽

Alexandre Lescszysnki ◽

Helvercio F P Alves

Keyword(s):

Endovascular Treatment ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Young Patients ◽

Case Series ◽

Arterial Occlusion ◽

Artery Dissection ◽

Surgical Morbidity ◽

Reconstructive Technique

Background: Spontaneous vertebral artery dissection (SVAD) is rare and occurs in young patients with subarachnoid hemorrhage (HSA) or stroke (3 to 5%). Only 11% occur in the V4 segment of VA. Its treatment changed in parallel with the progress of endovascular technology. Material and Methods: Six consecutive cases of dissecting vertebral artery aneurysms V4 are reported. All males with mean age 35 years. Clinical presentation with headache and neckache in all cases, ischemic stroke and SAH one case each. All patients underwent reconstructive endovascular treatment with FD stent, with or without microcoils. Results: All patients were under dual antiplatelet therapy before EVT (Aspirin 200mg and clopidogrel 75mg or ticagrelor 180mg/day). Reconstructive technique was performed with FD stent in two cases, associated of microcoils and “jailing technique” in two cases or multiple telescoping stents in three cases. Occlusion of the aneurysm and arterial permeability were found in long term follow up in 5 cases. In a case of fusiform aneurysm, there was late thrombosis of the telescoped stents and arterial occlusion without clinical repercussion. Conclusion: Due to the high rate of surgical morbidity, endovascular treatment became the first line for this kind of aneurysm. The reconstruction using a flow bypass and device reconstructive technique is an attractive alternative, showing long-term favorable clinical and angiographic outcomes with the ability to maintain patency of the parental and lateral branch arteries.

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Abstract 1122‐000200: Chiropractor Manipulation Leading to Bilateral Vertebral Artery Dissection and Acute Ischemic Stroke

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000200 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Christina Xia ◽

Lee Pfaff ◽

Navreet Kaur ◽

Neil Suryadevara ◽

Hesham Masoud

Keyword(s):

Vertebral Artery ◽

Motor Vehicle ◽

Vertebral Artery Dissection ◽

Clinical Signs ◽

The United States ◽

Homonymous Hemianopia ◽

Artery Dissection ◽

Multiple Chronic Conditions ◽

Cervical Artery Dissection ◽

Patient Reported

Introduction : Traumatic cervical artery dissection is one of the leading causes of stroke in patients under the age of 45. Recent chiropractic neck manipulation is associated with risk of vertebral artery dissection (VAD). The V3 segment of the vertebral artery is highly susceptible to the bending forces during forced manipulation leading to intimal damage. Methods : N/A Results : This is a case presentation of a 44 year old male who was transferred from another emergency department for left homonymous inferior quadrantanopia noted on an optometrist visit. He reported sudden onset left homonymous hemianopia after receiving a high velocity cervical spine adjustment at a chiropractor appointment for chronic neck pain a few days prior. CT angiogram of the head and neck revealed bilateral vertebral artery dissection at left V2 and right V3 segments. MRI brain confirmed an acute infract in the right medial occipital lobe. His right PCA stroke was likely embolic from the injured right V3 but possibly from the left V2 as well. As the patient reported progression from a homonymous hemianopia to a quadrantanopia, he likely had a migrating embolus. Conclusions : Arterial dissection accounts for about 2% of all ischemic strokes, but may be between 8–25% in patients less than 45 years old. VAD can result from trauma of varying severities ‐ from sports, motor vehicle accidents, and chiropractor neck manipulations to violent coughing/sneezing. It is estimated that 1 in 20,000 spinal manipulation results in vertebral artery aneurysm/dissection. In the United States, patients who have multiple chronic conditions are reporting higher use of complementary or alternative medicine, including chiropractic manipulation. Education about the association of VAD and chiropractor maneuvers can be beneficial to the public as these are preventable acute ischemic strokes. In addition, vertebral artery dissection symptoms can be subtle and patients presenting to chiropractors may have distracting pain masking their deficits. Evaluating for appropriateness of cervical manipulation in high‐risk patients and detecting early clinical signs of VAD by chiropractors can be beneficial in preventing acute ischemic strokes in young patients.

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Internal carotid and vertebral artery dissection: morphology, pathophysiology and provoking factors

Bulletin of Russian State Medical University ◽

10.24075/brsmu.2019.064 ◽

2019 ◽

pp. 72-78

Author(s):

LA Kalashnikova ◽

TS Gulevskaya ◽

AV Sakharova ◽

RP Chaykovskaya ◽

MV Gubanova ◽

...

Keyword(s):

Connective Tissue ◽

Vertebral Artery ◽

Arterial Wall ◽

Internal Carotid ◽

Vertebral Artery Dissection ◽

Clinical Signs ◽

Tissue Inhibitor Of Metalloproteinase ◽

Arterial Dissection ◽

Artery Dissection ◽

Elastic Membrane

The causes of internal carotid artery (ICA) and vertebral artery (VA) dissection, as well as its provoking factors, remain understudied. The aim of this paper was to explore morphological changes in the ICA/VA walls, factors provoking dissection, clinical signs and biomarkers of connective tissue (CT) damage. A total of 271 patients were examined, of whom 54% were women. The mean age of the participants was 37.0 ± 10 years. Clinical signs and biomarkers of CT damage (matrix metalloproteinase 9, tissue inhibitor of metalloproteinase 1, hydroxyproline, sulphated glycosaminoglycans) were analyzed in 82 patients and 40 healthy volunteers. Histologic examination of dissected and seemingly intact arteries conducted in 5 cases revealed signs of arterial wall dysplasia similar to those characteristics of fibromuscular dysplasia: thinning and splitting of the internal elastic membrane, areas of fibrosis, irregular orientation of myocytes, and their necrosis in the tunica media. Clinical signs and biomarkers of CT dysplasia (CTD) were more pronounced in patients with arterial dissection than in the controls. The major provoking factors were head turns and physical activity (42%), minor head injury (10%), and acute respiratory infection in the month preceding arterial dissection (14%). We conclude that arterial wall dysplasia is a predisposing factor for ICA/VA dissection, both spontaneous and provoked. The analysis of CTD biomarkers and clinical signs suggests connective tissue pathology in patients with ICA/VA dissection.

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