Neurological Disorders

Craniocervical Artery Dissection: Clinical and Imaging Mid-term Follow Up

Abstract

Seon-Kyu Lee, Kiron Thomas, Nicholas Tsapatsaris, Fawad Al-Mufti, Thomas Piemonte, Edward Jewel and Kinan Hreib

Background and objective: To analyze the temporal evolution of imaging findings and clinical follow up in craniocervical arterial dissection (CAD) patients. Methods: 32 patients (M: F=23: 9, mean age=49) with radiographic evidence of at least one of the suggestive imaging findings of CAD (arterial stenosis, arterial occlusion, luminal ectasia, pseudoaneurysm, and dissection flap) were performed. Median imaging follow up period was 89 days (SD=36.69). Clinical symptoms on presentation and follow up were also analyzed. Results: 21 patients had spontaneous dissection (65.6%). 11 had a history of trauma (34.4%). 14 (43.8%) patients presented with a stroke or TIA. Other presenting symptoms include headache (n=4, 12.5%), neck pain (n=9, 28.1%) and Horner’s syndrome (n=5, 15.6%). Involved arteries included Internal carotid artery (n=21, 65.6%), vertebral artery (n=10, 31.3%), and common carotid artery (n=3, 9.4%). Initial imaging findings included, arterial stenosis (n=23, 72%), arterial occlusion (n=6, 19%), ectasis of the lumen (n=7, 22%), pseudoaneurysm (n=12, 38%), and dissection flap (n=12, 38%). 21 patients were managed with anti-coagulation and 3 with an antiplatelet agent. On follow up imaging, arterial stenosis was improved in 73.6% (14/19), worse in 5.3% and no interval change in 21.1%. Regarding the pseudoaneurysm on presentation, no change in shape and size in 64% (7/11) and 2 patients developed new pseudoaneurysm. One patient developed a TIA (3.7%, n=1/27) during follow up. Conclusion: Post-dissection vascular imaging findings are dynamic. With medical management, more than 60% of the arterial stenosis lesions have improved within 3 months, and the risk of repeated neurological events were very low.