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Prognosis of spontaneous cervical artery dissection and transcranial Doppler findings associated with clinical outcomes

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Abstract

Objectives

We categorised spontaneous cervical artery dissection (sCAD) by radiological features and investigated factors associated with favourable outcomes.

Methods

We retrospectively analysed 128 patients with sCAD with a median follow-up duration of 25 months. Twenty-nine constituted the aneurysm group, 52 the stenotic group, and 47 the occlusive group. Various relevant factors, including National Institute of Health Stroke Scale (NIHSS) scores, type of antithrombotic therapy, stroke progression in the first week, and transcranial Doppler (TCD) flow-waveforms (in the occlusive subgroup) were analysed. Favourable outcomes were defined as a 1-year modified Rankin-Scale score of 0–1. Favourable anatomical outcomes were defined as a reversal of dissection-associated stenosis during follow-up.

Results

The aneurysm and stenotic groups showed favourable outcomes, while the occlusive group outcomes were less favourable. In the stenotic group, anticoagulation, an NIHSS score ≥4, and stroke progression were inversely associated with favourable long-term outcomes. Remarkably, in the occlusive group, flow abnormality more severe than minimal flow was associated with stroke progression, unfavourable long-term outcome, and arterial irreversibility.

Conclusions

The outcome of sCAD depends on its radiological subtype. In the occlusive subtype, which is associated with the worst outcome, TCD flow analysis may predict acute stroke progression and long-term outcome.

Key Points

• Outcomes in cervical artery dissection may be determined by radiological subtypes.

• The aneurysm and stenotic groups had favourable outcomes.

• The occlusive group had less favourable functional outcomes.

• Flow-waveform analysis by TCD could predict functional and anatomical outcomes.

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Acknowledgments

The scientific guarantor of this publication is Keun-Hwa Jung. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. The requirement for informed consent was waived, as the patients’ medical records and information were anonymized before our analysis. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Neurology, Seoul National University Hospital, Seoul, South Korea

    Woo-Jin Lee, Keun-Hwa Jung, Jangsup Moon, Soon-Tae Lee, Kon Chu, Sang-Kun Lee & Jae-Kyu Roh

  2. Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea

    Keun-Hwa Jung, Soon-Tae Lee, Kon Chu & Sang-Kun Lee

  3. Department of Neurology, The Armed Forces Capital Hospital, Sungnam, South Korea

    Jae-Kyu Roh

Authors
  1. Woo-Jin Lee
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  2. Keun-Hwa Jung
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Corresponding author

Correspondence to Keun-Hwa Jung.

Electronic supplementary material

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Supplemental Table 1

Comparison of clinical profiles between spontaneous vertebral and internal carotid artery dissection patients (DOCX 22 kb)

Supplemental Table 2

Factors associated with favourable outcome in the occlusive group: multivariate analysis including flow pattern abnormality (DOCX 20 kb)

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Lee, WJ., Jung, KH., Moon, J. et al. Prognosis of spontaneous cervical artery dissection and transcranial Doppler findings associated with clinical outcomes. Eur Radiol 26, 1284–1291 (2016). https://doi.org/10.1007/s00330-015-3944-4

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  • DOI: https://doi.org/10.1007/s00330-015-3944-4

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