Premium
Extracranial and intracranial vertebral artery dissection: Long‐term clinical and duplex sonographic follow‐up
Author(s) -
Wessels Tiemo,
Mosso Maria,
Krings Timo,
Klötzsch Christof,
Harrer Judith U.
Publication year - 2008
Publication title -
journal of clinical ultrasound
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.272
H-Index - 61
eISSN - 1097-0096
pISSN - 0091-2751
DOI - 10.1002/jcu.20511
Subject(s) - medicine , vertebral artery dissection , asymptomatic , radiology , digital subtraction angiography , stroke (engine) , magnetic resonance angiography , angiography , vertebral artery , stenosis , occlusion , vertebrobasilar insufficiency , dissection (medical) , magnetic resonance imaging , surgery , mechanical engineering , engineering
Purpose. To determine the value of color Doppler sonography (CDUS) in the diagnosis and follow‐up of patients with extracranial and intracranial vertebral artery (VA) dissection. Method. Thirty‐three patients aged 42 ± 12 years with 40 VADS confirmed via digital subtraction angiography (DSA) (n = 37) and magnetic resonance angiography (MRA) (n = 3) were included in the study. All patients were investigated with extracranial CDUS and transcranial CDUS (TCCDUS) over a mean ± SD follow‐up period of 42 ± 24 months and occurrence of new ischemic symptoms was assessed. Sonographic results were compared with initial and follow‐up angiographic results. Results. At presentation, 24/33 (73%) patients had suffered an ischemic stroke, 5/33 (15%) had a transient ischemic attack (TIA), and 4/33 (12%) were asymptomatic. Two patients had a recurrent vertebrobasilar TIA; there was no recurrent stroke. The initial DSA findings consisted of 14 stenoses, 20 tapered occlusions, and 6 pseudoaneurysms. During follow‐up, 63% of the vessels recanalized. Sonographic findings were consistent with angiographic findings in 80% at the initial examination and in 86% during follow‐up. The main reason for discordant results was the failure of CDUS to detect pseudoaneurysms. No recurrence occurred in the vertebral arteries (VA), but 1 patient had an asymptomatic carotid artery dissection during follow‐up. Conclusion. Recurrent TIA or stroke after VAD appears to be extremely rare, independent of recanalization or persistent occlusion of the affected artery. CDUS and TCCDUS provide reliable follow‐up of VAD in all patients presenting with stenosis or occlusion, but do not allow for detection of pseudoaneurysms of the VA. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2008