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

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

Interventional Neuroradiology ◽

10.1177/1591019917706190 ◽

2017 ◽

Vol 23 (4) ◽

pp. 350-356 ◽

Cited By ~ 3

Author(s):

Kenji Shimada ◽

Michihiro Tanaka ◽

Keisuke Kadooka ◽

Hiromu Hadeishi

Keyword(s):

High Resolution ◽

Vertebral Artery ◽

Cone Beam Ct ◽

Vertebral Artery Dissection ◽

Three Dimensional ◽

Major Complication ◽

Cone Beam ◽

Artery Dissection ◽

Ischemic Lesion ◽

Postoperative Mri

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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