Cervical Artery Dissection: Clinical Characteristics, Recanalization Follow-up And Prognostic Analysis In 42 Patients

Objective:To explore the clinical diagnosis, treatment and neurological outcome of cervical artery dissection(CAD), and analyze the correlation between outcome and recanalization assessed by ultrasound follow-up, with a view to help the management of CAD, decrease the incidence of stroke and improve the prognosis of stroke survivors by intervening certain factors.Methods:From June 2013 to October 2015, 42 consecutive patients with acute stroke or transient ischemic attack following occlusion or stenosis due to CAD admitted in the Department of Neurology, First Hospital of Shanxi Medical University were studied.Clinical data, which includes traditional risk factors, medical history, laboratory examinations and imageological examinations, were analyzed. All the patients were evaluated by neurovascular ultrasound at presentation then 3 to 6 months after discharge.At the same time neurological deficits were assessed using the modified Rankin Scale(mRS) and National Institutes of Health Stroke Scale(NIHSS).Results:Among 42 patients with CAD, 35 cases(83%) were internal carotid artery dissection and the rest of 7 cases(17%) were vertebral artery dissection. The commonest initial symptom was unilateral limb weakness with speech disorder, followed by headache, and most of the patients(69%)had no aura symptoms before stroke. For the 42 patients, including 39 with ischemic stroke and 3 with TIA. Ultrasound found all of the27 cervical artery occlusion cases( 64%), which were confirmed by computed tomography angiography(CTA) or digital subtraction angiography(DSA). The most typical sign of vascular imaging for the cervical artery occlusion was the "dual-chamber sign", followed by "flame sign". Most patients(50%) were treated Aspirin and clopidogrel. The NIHSS score of All the patients after treatment were decreased, and during the follow-up period new ischemic events did not appear. Arterial recanalization occurred in 13 of 42 patients with ultrasound follow-up and the recanalization time varied from 8 days to 6 months. There was no significant difference for general risk factors between patients with and without recanalization. Clinical outcome was correlated with initial infarct location rather than recanalization.Conclusion:1. For clinical suspected CAD patients, completing the cervical artery ultrasound as soon as possible was necessary. The convenience and high recognition rate of cervical artery ultrasound screening made it as the first choice for diagnosis. When ultrasound highly suspect CAD, the patient should admit antithrombosis as soon as possible rather than waiting for other vascular examination, then DSA or CTA can confirm the diagnosis. Besides, ultrasound can be used for reexamination and understanding the dynamic change of the artery.2. The examination and therapy of CAD should be individualized depend on the patient and hospital. The diagnosis of CAD should base on multi-vascular examination and clinical manifestation.3. The recanalization rate may be associated with the high blood pressure statement after CAD and the organization of hematoma, but need to be proved by further strictly designed studies.4.6 months neurological outcome was correlated with initial infarct location rather than recanalization.