The location of origin of spontaneous extracranial internal carotid artery dissection is adjacent to the skull base
Introduction The traditional view is that spontaneous extracranial internal carotid artery (ICA) dissection (CAD) extends cranially from an intimal tear located just beyond the carotid bulb. This paper demonstrates that CAD originates in and primarily involves a more distal segment of the artery. Me...
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| Veröffentlicht in: | Journal of medical imaging and radiation oncology 2014-08, Vol.58 (4), p.408-414 |
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| creator | Downer, Jonathon Nadarajah, Mahendra Briggs, Eliza Wrigley, Peter McAuliffe, William |
| description | Introduction
The traditional view is that spontaneous extracranial internal carotid artery (ICA) dissection (CAD) extends cranially from an intimal tear located just beyond the carotid bulb. This paper demonstrates that CAD originates in and primarily involves a more distal segment of the artery.
Methods
A retrospective study of 54 dissected ICAs in 50 consecutive patients with spontaneous or traumatic CAD was undertaken. The site of the dissection, presence of ICA redundancy, rate of acute or delayed ischaemic stroke and vessel remodelling were determined.
Results
Of the 51 dissections that occurred spontaneously or after indirect trauma, 25/51 (49.0%) were solely in the distal third of the artery, and 49/51 (96.1%) involved the distal two‐thirds. Only 2/51 (3.9%) originated in the proximal third. ICA redundancy was seen in 27/36 (75%) of patients with spontaneous CAD, compared with only 1/11 (9.1%) of those with CAD due to indirect trauma (P = 0.0002). Acute stroke occurred in 10/12 (83.3%) of patients with ICA occlusion secondary to CAD and in 14/38 (36.8%) with non‐occlusive CAD (P = 0.0074). Where follow‐up was available, only 2/32 (6.3%) patients had a stroke after diagnosis, and 19/33 (57.6%) ICAs recanalised or remodelled.
Conclusion
CAD occurring spontaneously or due to indirect trauma most frequently involves the distal extracranial ICA. Spontaneous CAD is associated with vessel redundancy, and the risk of acute stroke is greatest with occlusive CAD. The prognosis is good with treatment, with a low rate of recurrent stroke and a high rate of vessel remodelling. |
| doi_str_mv | 10.1111/1754-9485.12170 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1552374184</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3395759621</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5100-ae670111a1152d493548d08c25e92315a5fad89b94bf1f4b873b50b17a57ceb93</originalsourceid><addsrcrecordid>eNqFkc1v1DAQxS0Eoh9w5oYsceGS1uPYcXJEFWxblVaC8iEu1sRxwNtsvNiO6P73eDftHrjgi59Gv_dGM0PIK2AnkN8pKCmKRtTyBDgo9oQc7itP91qpA3IU45KxCkA0z8kBFxXjvGKHJN7-snTwBpPzI_U99cH9dDsV135MOFo_RWrvU0ATcHQ4UDcmG8YsDAafXEcx5MKGdi5Ga3ZBLlLslmjsmGjyNOUm8W4aBtpitC_Isx6HaF8-_Mfky4f3t2fnxdXN4uLs3VVhJDBWoK0Uy0MigOSdaEop6o7Vhkvb8BIkyh67umkb0fbQi7ZWZStZCwqlMrZtymPyds5dB_97sjHplYvGDsM8lAYpeakE1CKjb_5Bl37azrijoGasFpCp05kywccYbK_Xwa0wbDQwvb2H3m5cb7evd_fIjtcPuVO7st2efzxABtQM_HGD3fwvT19-vPh08xhdzE4Xk73fOzHc6UqVSupv1wt9ueDXn9X3H_pr-Rf6AqTA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1551800841</pqid></control><display><type>article</type><title>The location of origin of spontaneous extracranial internal carotid artery dissection is adjacent to the skull base</title><source>MEDLINE</source><source>Wiley Journals</source><creator>Downer, Jonathon ; Nadarajah, Mahendra ; Briggs, Eliza ; Wrigley, Peter ; McAuliffe, William</creator><creatorcontrib>Downer, Jonathon ; Nadarajah, Mahendra ; Briggs, Eliza ; Wrigley, Peter ; McAuliffe, William</creatorcontrib><description>Introduction
The traditional view is that spontaneous extracranial internal carotid artery (ICA) dissection (CAD) extends cranially from an intimal tear located just beyond the carotid bulb. This paper demonstrates that CAD originates in and primarily involves a more distal segment of the artery.
Methods
A retrospective study of 54 dissected ICAs in 50 consecutive patients with spontaneous or traumatic CAD was undertaken. The site of the dissection, presence of ICA redundancy, rate of acute or delayed ischaemic stroke and vessel remodelling were determined.
Results
Of the 51 dissections that occurred spontaneously or after indirect trauma, 25/51 (49.0%) were solely in the distal third of the artery, and 49/51 (96.1%) involved the distal two‐thirds. Only 2/51 (3.9%) originated in the proximal third. ICA redundancy was seen in 27/36 (75%) of patients with spontaneous CAD, compared with only 1/11 (9.1%) of those with CAD due to indirect trauma (P = 0.0002). Acute stroke occurred in 10/12 (83.3%) of patients with ICA occlusion secondary to CAD and in 14/38 (36.8%) with non‐occlusive CAD (P = 0.0074). Where follow‐up was available, only 2/32 (6.3%) patients had a stroke after diagnosis, and 19/33 (57.6%) ICAs recanalised or remodelled.
Conclusion
CAD occurring spontaneously or due to indirect trauma most frequently involves the distal extracranial ICA. Spontaneous CAD is associated with vessel redundancy, and the risk of acute stroke is greatest with occlusive CAD. The prognosis is good with treatment, with a low rate of recurrent stroke and a high rate of vessel remodelling.</description><identifier>ISSN: 1754-9477</identifier><identifier>EISSN: 1754-9485</identifier><identifier>DOI: 10.1111/1754-9485.12170</identifier><identifier>PMID: 24602260</identifier><language>eng</language><publisher>Australia: Blackwell Publishing Ltd</publisher><subject>Adult ; adult neuroimaging ; Aged ; Anatomic Landmarks - diagnostic imaging ; Anatomic Landmarks - pathology ; angiography ; Carotid Artery, Internal, Dissection - diagnosis ; Carotid Artery, Internal, Dissection - epidemiology ; Cerebral Angiography - statistics & numerical data ; Comorbidity ; Dissection ; Female ; Humans ; Incidence ; Magnetic Resonance Angiography - statistics & numerical data ; magnetic resonance imaging ; Male ; Middle Aged ; neurointerventional radiology ; neuroradiology ; Reproducibility of Results ; Risk Factors ; Sensitivity and Specificity ; Skull Base - diagnostic imaging ; Skull Base - pathology ; Stroke ; Stroke - diagnosis ; Stroke - epidemiology ; vascular imaging ; Veins & arteries ; Western Australia - epidemiology ; Young Adult</subject><ispartof>Journal of medical imaging and radiation oncology, 2014-08, Vol.58 (4), p.408-414</ispartof><rights>2014 The Royal Australian and New Zealand College of Radiologists</rights><rights>2014 The Royal Australian and New Zealand College of Radiologists.</rights><rights>Copyright © 2014 Royal Australian and New Zealand College of Radiologists</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5100-ae670111a1152d493548d08c25e92315a5fad89b94bf1f4b873b50b17a57ceb93</citedby><cites>FETCH-LOGICAL-c5100-ae670111a1152d493548d08c25e92315a5fad89b94bf1f4b873b50b17a57ceb93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2F1754-9485.12170$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2F1754-9485.12170$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24602260$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Downer, Jonathon</creatorcontrib><creatorcontrib>Nadarajah, Mahendra</creatorcontrib><creatorcontrib>Briggs, Eliza</creatorcontrib><creatorcontrib>Wrigley, Peter</creatorcontrib><creatorcontrib>McAuliffe, William</creatorcontrib><title>The location of origin of spontaneous extracranial internal carotid artery dissection is adjacent to the skull base</title><title>Journal of medical imaging and radiation oncology</title><addtitle>Journal of Medical Imaging and Radiation Oncology</addtitle><description>Introduction
The traditional view is that spontaneous extracranial internal carotid artery (ICA) dissection (CAD) extends cranially from an intimal tear located just beyond the carotid bulb. This paper demonstrates that CAD originates in and primarily involves a more distal segment of the artery.
Methods
A retrospective study of 54 dissected ICAs in 50 consecutive patients with spontaneous or traumatic CAD was undertaken. The site of the dissection, presence of ICA redundancy, rate of acute or delayed ischaemic stroke and vessel remodelling were determined.
Results
Of the 51 dissections that occurred spontaneously or after indirect trauma, 25/51 (49.0%) were solely in the distal third of the artery, and 49/51 (96.1%) involved the distal two‐thirds. Only 2/51 (3.9%) originated in the proximal third. ICA redundancy was seen in 27/36 (75%) of patients with spontaneous CAD, compared with only 1/11 (9.1%) of those with CAD due to indirect trauma (P = 0.0002). Acute stroke occurred in 10/12 (83.3%) of patients with ICA occlusion secondary to CAD and in 14/38 (36.8%) with non‐occlusive CAD (P = 0.0074). Where follow‐up was available, only 2/32 (6.3%) patients had a stroke after diagnosis, and 19/33 (57.6%) ICAs recanalised or remodelled.
Conclusion
CAD occurring spontaneously or due to indirect trauma most frequently involves the distal extracranial ICA. Spontaneous CAD is associated with vessel redundancy, and the risk of acute stroke is greatest with occlusive CAD. The prognosis is good with treatment, with a low rate of recurrent stroke and a high rate of vessel remodelling.</description><subject>Adult</subject><subject>adult neuroimaging</subject><subject>Aged</subject><subject>Anatomic Landmarks - diagnostic imaging</subject><subject>Anatomic Landmarks - pathology</subject><subject>angiography</subject><subject>Carotid Artery, Internal, Dissection - diagnosis</subject><subject>Carotid Artery, Internal, Dissection - epidemiology</subject><subject>Cerebral Angiography - statistics & numerical data</subject><subject>Comorbidity</subject><subject>Dissection</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Magnetic Resonance Angiography - statistics & numerical data</subject><subject>magnetic resonance imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>neurointerventional radiology</subject><subject>neuroradiology</subject><subject>Reproducibility of Results</subject><subject>Risk Factors</subject><subject>Sensitivity and Specificity</subject><subject>Skull Base - diagnostic imaging</subject><subject>Skull Base - pathology</subject><subject>Stroke</subject><subject>Stroke - diagnosis</subject><subject>Stroke - epidemiology</subject><subject>vascular imaging</subject><subject>Veins & arteries</subject><subject>Western Australia - epidemiology</subject><subject>Young Adult</subject><issn>1754-9477</issn><issn>1754-9485</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1v1DAQxS0Eoh9w5oYsceGS1uPYcXJEFWxblVaC8iEu1sRxwNtsvNiO6P73eDftHrjgi59Gv_dGM0PIK2AnkN8pKCmKRtTyBDgo9oQc7itP91qpA3IU45KxCkA0z8kBFxXjvGKHJN7-snTwBpPzI_U99cH9dDsV135MOFo_RWrvU0ATcHQ4UDcmG8YsDAafXEcx5MKGdi5Ga3ZBLlLslmjsmGjyNOUm8W4aBtpitC_Isx6HaF8-_Mfky4f3t2fnxdXN4uLs3VVhJDBWoK0Uy0MigOSdaEop6o7Vhkvb8BIkyh67umkb0fbQi7ZWZStZCwqlMrZtymPyds5dB_97sjHplYvGDsM8lAYpeakE1CKjb_5Bl37azrijoGasFpCp05kywccYbK_Xwa0wbDQwvb2H3m5cb7evd_fIjtcPuVO7st2efzxABtQM_HGD3fwvT19-vPh08xhdzE4Xk73fOzHc6UqVSupv1wt9ueDXn9X3H_pr-Rf6AqTA</recordid><startdate>201408</startdate><enddate>201408</enddate><creator>Downer, Jonathon</creator><creator>Nadarajah, Mahendra</creator><creator>Briggs, Eliza</creator><creator>Wrigley, Peter</creator><creator>McAuliffe, William</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201408</creationdate><title>The location of origin of spontaneous extracranial internal carotid artery dissection is adjacent to the skull base</title><author>Downer, Jonathon ; Nadarajah, Mahendra ; Briggs, Eliza ; Wrigley, Peter ; McAuliffe, William</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5100-ae670111a1152d493548d08c25e92315a5fad89b94bf1f4b873b50b17a57ceb93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>adult neuroimaging</topic><topic>Aged</topic><topic>Anatomic Landmarks - diagnostic imaging</topic><topic>Anatomic Landmarks - pathology</topic><topic>angiography</topic><topic>Carotid Artery, Internal, Dissection - diagnosis</topic><topic>Carotid Artery, Internal, Dissection - epidemiology</topic><topic>Cerebral Angiography - statistics & numerical data</topic><topic>Comorbidity</topic><topic>Dissection</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Magnetic Resonance Angiography - statistics & numerical data</topic><topic>magnetic resonance imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>neurointerventional radiology</topic><topic>neuroradiology</topic><topic>Reproducibility of Results</topic><topic>Risk Factors</topic><topic>Sensitivity and Specificity</topic><topic>Skull Base - diagnostic imaging</topic><topic>Skull Base - pathology</topic><topic>Stroke</topic><topic>Stroke - diagnosis</topic><topic>Stroke - epidemiology</topic><topic>vascular imaging</topic><topic>Veins & arteries</topic><topic>Western Australia - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Downer, Jonathon</creatorcontrib><creatorcontrib>Nadarajah, Mahendra</creatorcontrib><creatorcontrib>Briggs, Eliza</creatorcontrib><creatorcontrib>Wrigley, Peter</creatorcontrib><creatorcontrib>McAuliffe, William</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of medical imaging and radiation oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Downer, Jonathon</au><au>Nadarajah, Mahendra</au><au>Briggs, Eliza</au><au>Wrigley, Peter</au><au>McAuliffe, William</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The location of origin of spontaneous extracranial internal carotid artery dissection is adjacent to the skull base</atitle><jtitle>Journal of medical imaging and radiation oncology</jtitle><addtitle>Journal of Medical Imaging and Radiation Oncology</addtitle><date>2014-08</date><risdate>2014</risdate><volume>58</volume><issue>4</issue><spage>408</spage><epage>414</epage><pages>408-414</pages><issn>1754-9477</issn><eissn>1754-9485</eissn><abstract>Introduction
The traditional view is that spontaneous extracranial internal carotid artery (ICA) dissection (CAD) extends cranially from an intimal tear located just beyond the carotid bulb. This paper demonstrates that CAD originates in and primarily involves a more distal segment of the artery.
Methods
A retrospective study of 54 dissected ICAs in 50 consecutive patients with spontaneous or traumatic CAD was undertaken. The site of the dissection, presence of ICA redundancy, rate of acute or delayed ischaemic stroke and vessel remodelling were determined.
Results
Of the 51 dissections that occurred spontaneously or after indirect trauma, 25/51 (49.0%) were solely in the distal third of the artery, and 49/51 (96.1%) involved the distal two‐thirds. Only 2/51 (3.9%) originated in the proximal third. ICA redundancy was seen in 27/36 (75%) of patients with spontaneous CAD, compared with only 1/11 (9.1%) of those with CAD due to indirect trauma (P = 0.0002). Acute stroke occurred in 10/12 (83.3%) of patients with ICA occlusion secondary to CAD and in 14/38 (36.8%) with non‐occlusive CAD (P = 0.0074). Where follow‐up was available, only 2/32 (6.3%) patients had a stroke after diagnosis, and 19/33 (57.6%) ICAs recanalised or remodelled.
Conclusion
CAD occurring spontaneously or due to indirect trauma most frequently involves the distal extracranial ICA. Spontaneous CAD is associated with vessel redundancy, and the risk of acute stroke is greatest with occlusive CAD. The prognosis is good with treatment, with a low rate of recurrent stroke and a high rate of vessel remodelling.</abstract><cop>Australia</cop><pub>Blackwell Publishing Ltd</pub><pmid>24602260</pmid><doi>10.1111/1754-9485.12170</doi><tpages>7</tpages></addata></record> |
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| ispartof | Journal of medical imaging and radiation oncology, 2014-08, Vol.58 (4), p.408-414 |
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| subjects | Adult adult neuroimaging Aged Anatomic Landmarks - diagnostic imaging Anatomic Landmarks - pathology angiography Carotid Artery, Internal, Dissection - diagnosis Carotid Artery, Internal, Dissection - epidemiology Cerebral Angiography - statistics & numerical data Comorbidity Dissection Female Humans Incidence Magnetic Resonance Angiography - statistics & numerical data magnetic resonance imaging Male Middle Aged neurointerventional radiology neuroradiology Reproducibility of Results Risk Factors Sensitivity and Specificity Skull Base - diagnostic imaging Skull Base - pathology Stroke Stroke - diagnosis Stroke - epidemiology vascular imaging Veins & arteries Western Australia - epidemiology Young Adult |
| title | The location of origin of spontaneous extracranial internal carotid artery dissection is adjacent to the skull base |
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