Long-Term Sonographical Follow-Up of Arterial Stenosis Due to Spontaneous Cervical Artery Dissection

Abstract

Purpose: Little is known about the long-term course of arterial stenosis after spontaneous cervical artery dissection (sCAD). We analyzed changes over time and evaluated factors potentially associated with these changes and recurring sCAD.

Materials and methods: Adult patients with sCAD, admitted to our neurological department between 2004 and 2018, were included. All patients underwent initial and follow-up repetitive neurovascular ultrasound for a mean duration of 15.3 ± 21 months. Clinical and imaging data were registered for each patient.

Results: A total of 259 sCADs were diagnosed in 224 patients. Either internal carotid arteries (n = 133, 59.4%), vertebral arteries (n = 58, 25.9%), or multiple arteries (n = 33, 14.7%) were affected. In 93 out of 183 patients (51%), and in 117 out of 210 arteries under investigation (55.7%), vascular stenosis decreased over time. Occluded arteries recanalized early in 34 (54%) and stayed occluded in 29 patients (46.0%). Of 145 initially hemodynamically relevant stenosis, 77 (53.1%) improved over time. Overall, 12 patients (5.4 %) had a recurring sCAD during follow-up. Pseudoaneurysms were found in 19 patients.

Conclusion: The sonographical course of sCAD is highly dynamic within the first year after disease onset and should be monitored carefully. Decreasing degrees of stenosis and recanalization of occluded arteries occurred in half of all patients. Recurrent sCAD was a rare event in our cohort.

Keywords: neurovascular ultrasound; rare causes of stroke; spontaneous cervical artery dissection; stenosis; stroke.

Figure 1

(A) 48-year-old patient with neck pain; wall hematoma in B-mode (indicated by red arrow). (B) Corresponding magnetic resonance angiography with evidence of long-distance, irregular lumen narrowing in both vertebral arteries (indicated by red arrows). (C) Wall hematoma and lumen narrowing in B-mode, moderate stenosis (blood flow velocity: 160 cm/s).

Figure 2

(A) 42-year-old patient with transient aphasia, paresthesia on the right, Horner syndrome on the left; Occlusion signal indicates occlusion of the internal carotid artery. (B) Neurovascular ultrasound done 3 days later shows recanalization with evidence of a wall hematoma.

Figure 3

Degrees of stenosis of all cervical artery dissections over time. Degrees of stenosis were classified by neurovascular ultrasound according to the following scheme: 0: No visible stenosis, 1: Stenosis without hemodynamic relevance, 2: ≥50% difference in flow and/or acceleration of flow comparing healthy and affected sides, 3: 60–80% stenosis, 4: >80% stenosis, and 5: Arterial occlusion. N-numbers refer to patients being followed up for a certain period of time.