Analysis Of Clinical Features And Risk Factors Of Cervicocerebral Artery Dissection

BackgroundCervicocerebral artery dissection(CAD)is a cerebrovascular disease with clinical manifestations such as head and neck pain,Horner syndrome,ischemic stroke,cranial nerve palsy,and subarachnoid hemorrhage.One of the common causes of stroke,especially in young and middle-aged patients with ischemic stroke without traditional vascular risk factors.CAD is caused by various reasons for the blood in the arterial blood vessels to enter the vascular wall through the damaged and torn intima,forming an intramural hematoma between the intima of the blood vessel and the media,or a tumor-like expansion between the media and the adventitia.This can cause symptoms of cerebral ischemia or subarachnoid hemorrhage.Epidemiological results show that CAD patients account for 2%of ischemic stroke patients of all ages,especially among 15-49-year-old ischemic stroke patients.The cause of ischemic stroke is as high as 15%:CAD includes dissection of the vertebrobasilar system and dissection of the internal carotid system.According to the dissection involving the blood vessels of the head and neck arteries,CAD is divided into intracranial artery dissection(IAD)and extracranial artery dissection(EAD).In previous reports,the incidence of extracranial artery dissection is higher and more common in European population,while intracranial artery dissection is more common in Asian population.There are many studies on the pathogenesis,clinical characteristics and risk factors of extracranial artery dissection.Due to the limitations of imaging examination and clinical experience,the diagnosis rate of intracranial artery dissection is low,and the pathogenesis and risk factors are poorly understood.For example,a history of minor head and neck trauma may only be a risk factor for head and neck arterial dissection,but no research has confirmed whether it is a risk factor for intracranial arterial dissection,because most researchers have used intracranial arterial dissection and extracranial arterial dissection as the overall study,however,there are fewer studies on the differences in vascular risk factors between intracranial and extracranial arterial dissections,so further research is needed to confirm the difference in risk factors between intracranial and external cranial arterial dissections.ObjectiveIn this study,the risk factors and clinical characteristics of cervicocerebral artery dissection cases were collected in detail,and the differences between the two groups of risk factors and clinical characteristics of intracranial artery dissection and extracranial artery dissection were analyzed.Provide more help for clinicians to diagnose and treat cervicocerebral artery dissectionMethodsCollected 265 CAD patients diagnosed and treated in the Department of Neurology and Interventional Neurology of the First Affiliated Hospital of Zhengzhou University from January 2010 to August 2019.According to the involvement of dissection,they were divided into 160 cases of intracranial artery dissection.There were 105 cases of extracranial artery dissection group.The vascular risk factors and clinical characteristics of these cases were collected,and the potential risk factors and clinical characteristics of the two groups were compared and analyzed.Result:1.General dataA total of 265 CAD patients were included in this study,with an average age of onset(49.1 ± 13.0)years,105 in the EAD group and 160 in the LAD group,including 187 males,accounting for 70.6%of all patients.There were 100 cases of internal carotid artery dissection and 116 cases of vertebral artery dissection.Among 105 EAD patients,the extracranial internal carotid artery dissection was the most common,accounting for 79.0%(83/105),followed by the extracranial vertebral artery dissection accounting for 15.2%(16/105),and 4 patients had internal carotid and vertebral artery dissection,2 cases of subclavian artery dissection.Among 160 IAD patients,intracranial vertebral dissection was the most common,accounting for 62.5%(100/160),followed by basal artery dissection,accounting for 18.1(29/160),11 cases of middle cerebral artery dissection,and 1 case of posterior cerebral artery dissection.One dissection of the anterior inferior cerebellum and one dissection of the internal carotid and vertebral arteries.2.The clinical features of cervicocerebral artery dissectionCompared with the EAD group,patients in the IAD group were more prone to headache symptoms(58.8%vs 15.5%,P=0.002),more likely to form dissecting aneurysms(76.3%vs 40.0%,P<0.001),the average NHISS score of patients with ischemic stroke was higher(2.5±3.9 points vs 1.4± 2.8 points,P=0.012),and the diagnosis average time for dissection was longer(9.6 ± 6.1 days vs 8.2± 2.8 days,P=0.026);the EAD group was easier than the IAD group Symptoms of pulsating tinnitus(24.8%vs 12.5%,P=0.021),Homer syndrome(9.5%vs 2.5%,P=0.012),multiple dissections(20.0%vs 5.0%,P<0.001),more prone to ischemic stroke(59.0%vs 45.0%,P=0.025),is more likely to involve the anterior circulation(60.0%vs 20.0%,P<0.001).3.The risk factor analysis of cervicocerebral artery dissectionCompared with the EAD group,the average age of onset was higher in the IAD group(51.1 ± 13.6 vs 46.1 ± 11.5,P=0.002);while the EAD group had a more history of head and neck trauma than the IAD group(57.1%vs 26.3%,P<0.001).4.Comparative analysis of risk factors and clinical characteristics of internal cervical dissection and vertebral artery dissectionIntracranial vertebral artery dissection group is more likely to form dissecting aneurysm than patients in internal carotid artery dissection group(89.0%vs 58.8%,P<0.001),and more prone to headache symptoms(77.0%vs 35.3%,P=0.006);The internal carotid artery dissection group was more prone to ischemic stroke events than the vertebral artery dissection group(76.5%vs 37.0%,P=0.002).Dissection of the extracranial vertebral artery dissection group is more likely to form dissection aneurysms than patients with internal carotid artery dissection group(68.8%vs 33.7%,P=0.009).Conclusions:1.The extracranial artery dissection is more prone to Horner syndrome,pulsating tinnitus,and multiple dissections than the intracranial artery dissection.It is prone to ischemic stroke,involving the anterior circulation,and often has a history of head and neck trauma.2.The intracranial artery dissection is more prone to headache symptoms and the formation of dissection aneurysms than the extracranial artery dissection.The symptoms of ischemic stroke are more severe.3.The extracranial vertebral artery dissection is more likely to form dissecting aneurysms than the internal carotid dissection patients;the intracranial vertebral artery dissection is more prone to headache symptoms and the formation of dissection aneurysms than the internal carotid artery dissection,and the internal carotid artery dissection is more prone to ischemic stroke.