Abstract 3626: Cranio Cervical Arterial Dissection; Radiologic Variants And The Natural History, Treatment, And Prognosis

Background and Objective: Craniocervical arterial dissection (CCAD) is believed to have a relatively benign natural history & generally is managed with anticoagulation or antiplatelet therapy.The purpose of this study is to identify whether clinicoradiological parameters affect prognosis of CCAD. Methods: 26 patients(M: F=12:14, mean age=41.57) with clinical evidence of CCAD and at least one of the following suggestive imaging findings on either CT Angiography or MR angiography were included. Suggestive imaging findings include:1) arterial stenosis,2) arterial occlusion, 3) ectatic change of lumen,4) pseudoaneurysm,and 5) dissection flap. The temporal clinical and radiological evolution of CCAD findings were analyzed by a stroke neurologist and neuroradiologist respectively. Results: 69.2% had spontaneous dissections (n=18/26), and 30.7%had a history of trauma (n=8/26). 15 patients presented with strokes(15/26, 57.6%), three patients had TIA(11.5%), 13 patients had neck pain (50%), and 6 patients presented with Horner’s syndrome (21%). Anterior circulation dissection contributed 23%(6/26) of all dissections and posterior circulation dissections were 76.9%(20/26), while the vast majority of cases were unilateral,3.8% of cases were bilateral(1/26). Although 38.4% (n=10/26) were lost to follow up, 61%(n=16/26) had at least one follow up vascular imaging study. Neuroradiologic evaluation of these patients revealed arterial stenoses, arterial occlusions, ectatic changes of the lumen, pseudoaneurysms, and dissection flaps. Pseudo aneurysms were present in 15.4%(n:4/26) of cases.Recanalization had occurred in 75% (12/16), while 25 % did not recanalize within 2-5 months with a mean duration of 71 days.All patients were managed with anticoagulation or antiplatelet therapy. During the follow up period, all patients were stable, without any additional neurologic sequelae.50%(n=4/8) of the traumatic cases were associated with stroke while spontaneous dissections were associated with strokes in approximately 61%(n=11/18).With regards to age we found that 70% of patients between the ages of 38 - 65 years of age had developed strokes while only 30% of those aged 21 - 35 years old had developed strokes. Conclusion: The results revealed a distinction in the prognosis based upon age and the CCAD subtypes. Younger patients were less likely to present with a stroke than their older counterparts.Radiologic subtypes of CCAD as previously demonstrated in our previous study(Lee et al) supported our data which revealed that patients with pseudoaneurysm and intimal flap do not change over time despite treatment.With medical management, more than half of the arterial stenoses after craniocervical dissection improved within a relatively short period of time and no further neurologic sequelae were observed.