Analysis Of Clinical Characteristics Of 74 Cases With Cerebral Artery Dissection

Objective:We collected the clinical data of patients with Cerebral Artery Dissection(CAD)and analyzed the differences between clinical features of intracranial artery dissection(IAD)and extracranial artery dissection(EAD),to provide evidence for the early diagnosis and treatment of cerebral artery dissection,especially intracranial artery dissection.Methods:74 CAD patients admitted to the Second Affiliated Hospital of Nanchang University from August 2017 to March 2021 were selected and divided into the intracranial dissection group(41 cases)and the extracranial dissection group(33cases)according to the dissection vessel segmentation.The differences of demography,risk factors,clinical manifestations and imaging features between the two groups were compared.Results:1.Demographic analysisFinally,74 CAD patients were enrolled,with 41 cases(55.4%)in IAD group and33cases(44.6%)in EAD group.Among them,there were 26 males(63.4%)and 15females(36.6%)in the IAD group.The ratio of male to female was 1.7:1,and the age of onset ranged from 23 to 76 years old,with an average age of 51.7±9.6 years old.In the EAD group,there were 22 males(66.7%)and 11 females(33.3%),with a male-to-female ratio of 2:1.The age of onset ranged from 16 to 67 years old,and the mean age of onset was(46.6±12.8)years old.The onset age of the IAD group was older than that of the EAD group,and the difference was statistically significant(P=0.047).There was no significant difference in sex ratio between the groups.2.Analysis of risk factorsIn the IAD group,19 patients(46.3%)had hypertension and 17 patients(41.5%)used to smoked.In the EAD group,11 patients(33.3%)had hypertension and 10patients(30.3%)used to smoked.Among vascular risk factors,hypertension and smoking were common in both IAD and EAD groups.There were no significant differences between the two groups in all vascular risk factors and medical history,season of onset,recent infection,minor trauma,BMI and serological indexes.3.Analysis of clinical manifestation and stroke mechanismThe incidence of head and neck pain in the IAD group was higher than that in the EAD group(51.2% vs 27.3%,P=0.037).There were no significant differences in the rates of ischemic stroke,TIA,SAH or other non-specific manifestations between two groups.The incidence of stroke caused by occlusion of perforating artery in IAD group was higher than that in EAD group(42.9% vs 6.3%,P=0.031).there was no significant difference in the proportion of stroke caused by thromboembolism,hemodynamic failure,in situ thrombotic occlusion and mixed mechanisms between the two groups.In the IAD group,one patient(2.4%)had multiple arterial dissection.In the EAD group 3 patients(9.1%)had multiple arterial dissection.There was no significant difference in the incidence of multiple arterial dissection between the two groups.4.Analysis of imaging featuresThe proportion of posterior circulation artery dissection(80.5% vs 24.2%,P <0.001)and vertebral artery dissection(58.5% vs 24.2%,P=0.003)in IAD group was higher than that in EAD group.In contrast,more cases of anterior circulation artery dissection(75.8% vs19.5%,P < 0.001)and internal carotid artery dissection(75.8%vs 4.9%,P < 0.001)occurred in the EAD group than in the IAD group,and the distribution of other location was similar among the groups.Compared with the EAD group,dissecting aneurysms were more common in the IAD group(63.4% vs 39.4%,P=0.040),and there was no significant difference in the proportion of stenosis,occlusion or stenosis with dissecting aneurysms between the two groups.Conclusions:1.Compared with extracranial artery dissection,intracranial artery dissection is more common and the average age of onset is older.2.Compared with extracranial artery dissection,head and neck pain is more common,the incidence of stroke caused by occlusion of perforating artery in IAD group was higher.3.Compared with extracranial artery dissection,posterior circulation and vertebral artery involvement of intracranial artery dissection are more common and more likely to be accompanied by dissecting aneurysm.On the contrary,anterior circulation and internal carotid artery were more involved in extracranial artery dissection.