Introduction: Cervicocephalic arterial dissection is a vascular condition caused by a cleavage within the arterial wall. While frequently investigated by radiologists, it remains less familiar to frontline clinicians. Objective: The primary objective of this study was to assess the clinical course and outcomes of intra- and extracranial arterial dissections. Methods: We conducted a single-center, retrospective and prospective descriptive study including 30 cases of carotid and/or vertebral dissections hospitalized between January 2018 and August 2023 in the Neurology Department of the Centre Hospitalier du Pays d’Aix en Provence. Magnetic resonance angiography with Fat-Sat sequences was considered the essential diagnostic tool. Results: The mean patient age was 45.1 years. In one-third of cases, ischemic stroke was the initial presentation, most often involving vertebral arteries. During hospitalization, most patients received antiplatelet therapy (93.0%) and a smaller proportion anticoagulation (13.0%). Clinical recovery occurred in an average of 4.8 months in 79.0% of followed patients. Overall, short-term outcomes were favorable in all cases, with no deaths reported; however, 30.0% of patients were lost to follow-up. Conclusion: Patients admitted for arterial dissection are typically active working adults, often presenting first to the emergency department before referral to neurology. Prognosis is generally favorable under antiplatelet therapy. Stroke is an uncommon complication, except in vertebral dissections.
References
[1]
Stapf, C. and Arnold, M. (2010) Carotid Dissections: Histopathological Mechanisms and Patient Management. Réanimation, 19, 498-504.
[2]
François, G., Laurent, P., Eric, O. and Didier, L. (2019) Dissection carotidienne après 65 ans. RevueNeurologique, 175, S67. https://doi.org/10.1016/j.neurol.2019.01.192
[3]
Benninger, D.H., Georgiadis, D., Kremer, C., Studer, A., Nedeltchev, K. and Baumgartner, R.W. (2004) Mechanism of Ischemic Infarct in Spontaneous Carotid Dissection. Stroke, 35, 482-485. https://doi.org/10.1161/01.str.0000109766.27393.52
[4]
Sztajzel, R., Perren, F. and Michel, P. (2017) Dissections carotidiennes et vertébrales spontanées. RevueMédicaleSuisse, 13, 900-906. https://doi.org/10.53738/revmed.2017.13.560.0900
[5]
Debette, S. and Leys, D. (2009) Cervical-Artery Dissections: Predisposing Factors, Diagnosis, and Outcome. TheLancetNeurology, 8, 668-678. https://doi.org/10.1016/s1474-4422(09)70084-5
[6]
Markus, H.S., Levi, C., King, A., Madigan, J. and Norris, J. (2019) Antiplatelet Therapy vs Anticoagulation Therapy in Cervical Artery Dissection: The Cervical Artery Dissection in Stroke Study (CADISS) Randomized Clinical Trial Final Results. JournalofVascularSurgery, 70, 2098-2099. https://doi.org/10.1016/j.jvs.2019.09.003
[7]
Souissi, W., Mariem, M., Zaouali, J., Derbali, H., Mansour, M. and Mrissa, R. (2017) Les dissections carotidiennes et vertébrales: Aspects cliniques, radiologiques et évolutifs. Revue Neurologique, 173, S169. https://doi.org/10.1016/j.neurol.2017.01.323
[8]
Fusco, M.R. and Harrigan, M.R. (2011) Cerebrovascular Dissections—A Review Part I: Spontaneous Dissections. Neurosurgery, 68, 242-257. https://doi.org/10.1227/neu.0b013e3182012323
[9]
Hoffmann, C., Augé, M., Falzone, E., Martel-Jacob, S. and Mercier, F.J. (2013) Dissection artérielle carotidienne bilatérale dans un contexte de prééclampsie sévère: Une cause inhabituelle de céphalées du post-partum. Annales Françaisesd’Anesthésie et de Réanimation, 32, 267-270. https://doi.org/10.1016/j.annfar.2013.02.008
[10]
Chan, M.T.Y., Nadareishvili, Z.G. and Norris, J.W. (2000) Diagnostic Strategies in Young Patients with Ischemic Stroke in Canada. CanadianJournalofNeurologicalSciences, 27, 120-124. https://doi.org/10.1017/s0317167100052215
[11]
Diouri, L., Guemmi, I., Ahsayen, F.Z., Amane, Y., Aqamour, R., Haddar, L., et al. (2023) Dissection et avc ischemique: A propos de 15 cas. JournalofNeuroradiology, 50, 161-162. https://doi.org/10.1016/j.neurad.2023.01.090
[12]
Van Damme, H., Martin, D., Stassen, M.P. and Limet, R. (1990) Dissections spontanées de la carotide interne. A propos de sept cas avec revue de la littérature. JournaldesMaladiesVasculaires, 15, 14-22. https://pubmed.ncbi.nlm.nih.gov/2179445/
[13]
Kotchene, E.C. (2024) Aspects cliniques, paracliniques et thérapeutiques des dissections artérielles cervicales au Centre Hospitalier René Dubos de Pontoise (CHRD). Collections. Mémoires de spécialisations. Faculté de Médecine et d’Odonto-Stomatologie de Bamako, 1-50.
[14]
Brown, S.P. (2024) Cervical Spine Manipulation and Causation of Cervical Artery Dissection: A Review of 10 Case Reports. Cureus, 16, e62845. https://doi.org/10.7759/cureus.62845
[15]
Debette, S., Mazighi, M., Bijlenga, P., Pezzini, A., Koga, M., Bersano, A., et al. (2021) ESO Guideline for the Management of Extracranial and Intracranial Artery Dissection. EuropeanStrokeJournal, 39, 82-86. https://doi.org/10.1177/23969873211046475
[16]
Furie, K.L., Kasner, S.E., Adams, R.J., Albers, G.W., Bush, R.L., Fagan, S.C., et al (2011) American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Interdisciplinary Council on Quality of Care and Outcomes Research Guidelines for the Prevention of Stroke in Patients with Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 42, 227-276.
