Angiographic frequency of saccular intracranial aneurysms in patients with spontaneous cervical artery dissection

1992 ◽  
Vol 76 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Wouter I. Schievink ◽  
Bahram Mokri ◽  
David G. Piepgras
Keyword(s):  
General Population ◽  
Intracranial Aneurysms ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Angiographic Study ◽  
Content Type ◽  
Cervical Artery ◽  
Male Patients ◽  
Fine Print

✓ The pathogenesis of intracranial aneurysms and spontaneous cervical artery dissection is incompletely understood but a primary arteriopathy, possibly similar in both disorders, may be of importance. To investigate the frequency of intracranial aneurysms in patients with spontaneous cervical artery dissection, the angiograms of 164 patients who were diagnosed at the Mayo Clinic as having spontaneous extracranial carotid or vertebral artery dissection were reviewed. Thirteen intracranial aneurysms were detected in nine (5.5%) of the 164 patients: eight (8.8%) of the 91 female patients and one (1.4%) of the 73 male patients. The frequency of intracranial aneurysms in these patients was significantly higher (p < 0.01) than that observed in a recent angiographic study from the same institution, estimating the frequency of intracranial aneurysms in the general population (1.1%). The significance of these findings is discussed.

Seasonal pattern of spontaneous cervical artery dissection

1998 ◽  
Vol 89 (1) ◽  
pp. 101-103 ◽  
Author(s):  
Wouter I. Schievink ◽  
Eelco F. M. Wijdicks ◽  
James D. Kuiper
Keyword(s):  
Seasonal Pattern ◽  
The United States ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Related Factors ◽  
Rayleigh Test ◽  
Content Type ◽  
Cervical Artery ◽  
Genetic And Environmental Factors ◽  
Fine Print

Object. The etiology of spontaneous cervical artery dissection is poorly understood; however, it may involve genetic and environmental factors. The purpose of this study was to determine whether seasonality of spontaneous cervical artery dissection exists. Methods. The seasonal pattern of spontaneous cervical artery dissection was analyzed in a group of 200 consecutive patients (104 females and 96 males with a mean age of 44.9 years) who were evaluated using the Rayleigh test during the period from 1970 to 1990. The majority of patients resided in the midwestern section of the United States, where large seasonal fluctuations in climate occur. A circannual periodicity was found in the frequency of spontaneous cervical artery dissections with a peak occurring in October (p < 0.02). The seasonal variation was substantial, with approximately 58% more patients suffering a cervical artery dissection during autumn than during other seasons. Conclusions. A seasonal pattern of spontaneous cervical artery dissection exists with a peak occurring in October. The cause of the seasonality remains to be explained; however, weather- or infectious disease—related factors may provide etiological leads.

scholarly journals Recurrence of cervical artery dissection: protocol for a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037124
Author(s):  
Elizabeth Lounsbury ◽  
Brian Dewar ◽  
Alexandra Davis ◽  
Dean A Fergusson ◽  
Dar Dowlatshahi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vertebral Artery Dissection ◽  
Primary Data ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Cochrane Central Register ◽  
Minor Trauma ◽  
Central Register ◽  
Cervical Artery ◽  
Registration Number

IntroductionCervical artery dissection, including carotid and vertebral artery dissection, is an important cause of stroke in the young. Risk of developing cervical artery dissection has been associated with physical activity in various forms and has been presumed to be related to minor trauma and mechanical stretching of the cervical arteries. This systematic review will aim to synthesise data on the risk of recurrent cervical artery dissection after an initial dissection. This information may be applied to further understand the natural history of this disease, and potentially to help direct evidence-based discussions on safe return to activity after dissection.Methods and analysisA broad search of multiple electronic databases (Medline, Embase, Cochrane Central Register of Controlled Trials and Web of Science) will be conducted to identify studies published as of 13 November 2019, examining all-comers with cervical artery dissection observed over time. Studies will be screened by two independent reviewers in a two-level process to determine eligibility for inclusion. Data will be pooled from eligible articles and the main outcome of recurrent cervical artery dissection at 5 years will be determined using quantitative analysis.Ethics and disseminationEthics approval is not necessary as no primary data are being collected. The information will be disseminated in the form of a systematic review article which will be submitted to a peer-reviewed medical journal.PROSPERO registration numberCRD42020166105.

α1-antitrypsin deficiency in intracranial aneurysms and cervical artery dissection

The Lancet ◽  
1994 ◽  
Vol 343 (8895) ◽  
pp. 452-453 ◽  
Author(s):  
W.I Schievink ◽  
D.G Piepgras ◽  
U.B.S Prakash ◽  
B Mokri
Keyword(s):  
Intracranial Aneurysms ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Cervical Artery ◽  
Antitrypsin Deficiency

scholarly journals Prevalence of Cervical Artery Dissection among Hospitalized Patients with Stroke by Age in a Nationally Representative Sample from the United States

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011420
Author(s):  
Yahya B. Atalay ◽  
Pirouz Piran ◽  
Abhinaba Chatterjee ◽  
Santosh Murthy ◽  
Babak B. Navi ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Representative Sample ◽  
Age Groups ◽  
Vertebral Artery Dissection ◽  
The United States ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Cervical Artery ◽  
Nationally Representative

Objective:To test the hypothesis that the prevalence of cervical artery dissection remains constant across age groups, we evaluated the relationship between age and cervical artery dissection in patients with stroke using a Nationally Representative Sample from the United States.Methods:We used inpatient claims data included in the 2012-2015 releases of the National Inpatient Sample (NIS). We used validated ICD-9-CM codes to identify adults hospitalized with ischemic stroke and a concomitant diagnosis of carotid- or vertebral-artery dissection. Survey weights provided by the NIS and population estimates from the U.S. census were used to calculate nationally representative estimates. The chi-square test for trend was used to compare the prevalence of concomitant dissection among stroke hospitalizations across patient subgroups defined by age. Poisson regression and the Wald test for trend were used to evaluate whether the prevalence of hospitalizations for stroke and concomitant dissection per million person-years varied by age groups.Results:There were 17,320 (95% confidence interval [CI], 15,614-19,026) hospitalizations involving ischemic stroke and a concomitant dissection. The prevalence of dissection among stroke hospitalizations decreased across 10-year age groups from 7.2% (95% CI, 6.2%-8.1%) among persons younger than age 30 years to 0.2% (95% CI, 0.1%-0.2%) among persons older than age 80 years (P value for trend <0.001). However, the prevalence of hospitalizations for stroke and concomitant dissection increased from 5.4 (95% CI, 4.6-6.2) hospitalizations per million person-years among adults younger than age 30 to 24.4 (95% CI, 21.0-27.9) hospitalizations per million person-years among adults older than age 80 (P value for trend <0.01).Conclusions:In a nationally representative sample, the prevalence of hospitalizations for dissection-related stroke increased with age.

Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients

2004 ◽  
Vol 101 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Masaru Yamada ◽  
Takao Kitahara ◽  
Akira Kurata ◽  
Kiyotaka Fujii ◽  
Yoshio Miyasaka
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Conservative Treatment ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Delayed Diagnosis ◽  
Acute Stage ◽  
Artery Dissection ◽  
Content Type ◽  
String Structure ◽  
Fine Print

Object. Intracranial vertebral artery (VA) dissection with subarachnoid hemorrhage is notorious for frequent rebleeding and a poor prognosis. Nevertheless, some patients survive with a good final outcome. The factors associated with the prognosis of this disease are not fully understood and appropriate treatment strategies continue to be debated. The authors retrospectively evaluated the clinical features of conservatively treated patients to elucidate the relationship between the clinical and angiographic characteristics of the disease and final outcomes. Methods. This study includes 24 patients who were treated by conservative methods between 1990 and 2000. Conservative treatment was chosen because of delayed diagnosis, poor clinical condition, or anatomical features such as bilateral lesions and contralateral VA hypoplasia. Of nine patients with an admission Hunt and Kosnik Grade I or II, eight had good outcomes (mean follow-up period 8 years and 4 months). All 15 patients with Grade III, IV, or V died and in 10 of these the cause of death was rebleeding. Among the 24 patients, 14 suffered a total of 35 rebleeding episodes; in 10 (71.4%) of these 14 patients rebleeding occurred within 6 hours and in 13 (93%) within 24 hours. Compared with the survivors, there was a female preponderance (0.022) among patients who died. These patients also had significantly shorter intervals between onset and hospital admission (p = 0.0067), a higher admission Hunt and Kosnik grade (p = 0.0001), a higher incidence of prehospitalization (p = 0.0296) and postadmission (p = 0.0029) rebleeding episodes, and a higher incidence of angiographically confirmed pearl-and-string structure of the lesion (p = 0.0049). Conclusions. In our series of preselected patients, poor admission neurological grade, rebleeding episode(s), and lesions with a pearl-and-string structure were predictive of poor outcomes. Our findings indicate that patients with these characteristics may be candidates for aggressive attempts to prevent rebleeding during the acute stage. Patients without these characteristics may be good candidates for conservative treatment, especially those who survive the acute phase without rebleeding.

Acute headache and persistent headache attributed to cervical artery dissection: Field testing of ICHD-III beta

Cephalalgia ◽  
2014 ◽  
Vol 34 (9) ◽  
pp. 712-716 ◽  
Author(s):  
Henrik W Schytz ◽  
Messoud Ashina ◽  
Melinda Magyari ◽  
Vibeke A Larsen ◽  
Jes Olesen ◽  
...  
Keyword(s):  
Vertebral Artery Dissection ◽  
Field Testing ◽  
Arterial Dissection ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Cervical Artery ◽  
Acute Headache ◽  
Persistent Headache ◽  
First Time

The criteria for headache attributed to cervical artery dissection have been changed in the new third edition of the International Classification of Headache Disorders (ICHD-III beta). We have retrospectively investigated 19 patients diagnosed from 2001 to 2006 with cervical artery dissection at onset and followed them up six months after dissection. At dissection onset 17/19 patients were classified as headache probably attributed to vascular disorder at the time of dissection using the ICHD second edition (ICHD-II) criteria. In contrast, 17/19 of patients fulfilled the ICHD-III beta criteria for Headache or facial or neck pain attributed to cervical carotid or vertebral artery dissection or Headache attributed to intracranial arterial dissection. Six months after dissection five of 19 patients still reported persistent headache attributed to dissection. The study demonstrates that the ICHD-III beta criteria for cervical artery dissection are useful for classifying patients at the first encounter. We show for the first time that persistent headache attributed to arterial dissection is frequent.

Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography

1994 ◽  
Vol 80 (4) ◽  
pp. 667-674 ◽  
Author(s):  
Chifumi Kitanaka ◽  
Jun-Ichi Tanaki ◽  
Masanori Kuwahara ◽  
Akira Teraoka ◽  
Tomio Sasaki ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Bed Rest ◽  
Arterial Dissection ◽  
Artery Dissection ◽  
Aneurysmal Dilatation ◽  
Content Type ◽  
Brain Stem Ischemia ◽  
Fine Print

✓ The question of whether unruptured intracranial vertebral artery dissections should be treated surgically or nonsurgically still remains unresolved. In this study, six consecutive patients with intracranial vertebral artery dissection presenting with brain-stem ischemia without subarachnoid hemorrhage (SAH) were treated nonsurgically with control of blood pressure and bed rest, and five received follow-up review with serial angiography. No further progression of dissection or associated SAH occurred in any of the cases, and all patients returned to their previous lifestyles. In the serial angiograms in five patients, the findings continued to change during the first few months after onset. Four cases ultimately showed “angiographic cure,” while fusiform aneurysmal dilatation of the affected vessel persisted in one case. In one patient, arterial dissection was visualized on the second angiogram despite negative initial angiographic findings. These results indicate that intracranial vertebral artery dissection presenting without SAH can be treated nonsurgically, with careful angiographic follow-up monitoring. Persistent aneurysmal dilatation as a sequela of arterial dissection seemed to form a subgroup of fusiform aneurysms of the posterior circulation. These aneurysms may be prone to late bleeding and may require surgical treatment.

Repair of a vertebral artery dissection

1986 ◽  
Vol 64 (4) ◽  
pp. 662-665 ◽  
Author(s):  
J. Jeffrey Alexander ◽  
Seymour Glagov ◽  
Christopher K. Zarins
Keyword(s):  
Vertebral Artery ◽  
Surgical Therapy ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Aggressive Approach ◽  
Content Type ◽  
Satisfactory Recovery ◽  
Fine Print

✓ The case is presented of a 38-year-old woman who suffered multiple cerebellar infarctions as a result of emboli from a vertebral artery dissection. Surgical therapy led to a satisfactory recovery. This case emphasizes the importance of an aggressive approach to such lesions.

Endovascular treatment of vertebral artery dissections and pseudoaneurysms

1993 ◽  
Vol 79 (2) ◽  
pp. 183-191 ◽  
Author(s):  
Van V. Halbach ◽  
Randall T. Higashida ◽  
Christopher F. Dowd ◽  
Kenneth W. Fraser ◽  
Tony P. Smith ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Transluminal Angioplasty ◽  
Artery Dissection ◽  
Parent Artery ◽  
Content Type ◽  
Balloon Test Occlusion ◽  
Endovascular Occlusion ◽  
Proximal Occlusion ◽  
Fine Print

✓ Sixteen patients with dissecting aneurysms or pseudoaneurysms of the vertebral artery, 12 involving the intradural vertebral artery and four occurring in the extradural segment, were treated by endovascular occlusion of the dissection site. Patients with vertebral fistulas were excluded from this study. The dissection was caused by trauma in three patients (two iatrogenic) and in the remaining 13 no obvious etiology was disclosed. Nine patients presented with subarachnoid hemorrhage (SAH), two of whom had severe cardiac disturbances secondary to the bleed. The nontraumatic dissections occurred in seven women and six men, with a mean age on discovery of 48 years. Fifteen patients were treated with endovascular occlusion of the parent artery at or just proximal to the dissection site. One patient had occlusion of a traumatic pseudoaneurysm with preservation of the parent artery. Four patients required transluminal angioplasty because of severe vasospasm produced by the presenting hemorrhage, and all benefited from this procedure with improved arterial flow documented by transcranial Doppler ultrasonography and arteriography. In 15 patients angiography disclosed complete cure of the dissection. One patient with a long dissection of extracranial origin extending intracranially had proximal occlusion of the dissection site. Follow-up angiography demonstrated healing of the vertebral artery dissection but persistent filling of the artery above the balloons, which underscores the need for embolic occlusion near the dissection site. No hemorrhages recurred. One patient had a second SAH at the time of therapy which was immediately controlled with balloons and coils. This patient and one other had minor neurological worsening resulting from the procedure (mild Wallenberg syndrome in one and minor ataxia in the second). Symptomatic vertebral artery dissections involving the intradural and extradural segments can be effectively managed by endovascular techniques. Balloon test occlusion and transluminal angioplasty can be useful adjuncts in the management of this disease.

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