Neurointervention.  2022 Jul;17(2):78-86. 10.5469/neuroint.2022.00143.

Clinical Manifestation and Radiologic Patterns of Spontaneous Cervicocephalic Dissection According to the Anatomic Location: A Single-Center Analysis in Korean Patients

• Song Y
• Park SI
• Budianto P
• Kwon B
• Suh DC

• KMID: 2531562
• DOI: http://doi.org/10.5469/neuroint.2022.00143

Abstract

Purpose
Spontaneous cervicocephalic dissection (SCAD) is an important cause of stroke and shows various lesion locations and clinical features. The purpose of this study was to analyze the location of SCAD and its clinical and radiologic patterns in Korean patients.
Materials and Methods
Patients with SCAD who were evaluated between 2013 and 2018 at a tertiary center in Korea were reviewed. We classified and compared the morphological (aneurysm or steno-occlusion) and presenting (hemorrhage or infarction) patterns according to the lesion locations (anterior circulation [AC] vs. posterior circulation [PC]; intradural [ID] vs. extradural [ED]).
Results
A total of 166 patients were included in this study. The SCAD most commonly occurred in the PC-ID location (65.1%), followed by AC-ID (13.3%), AC-ED (13.3%), and PC-ED (8.4%). Aneurysm and steno-occlusion patterns were observed in 66.9% and 57.8% of the cases, respectively. The aneurysm pattern was significantly more common in the PC-ID location (78.7%) than in other locations. As for the presenting pattern, cerebral infarction was the most common pattern (39.8%), and intracranial hemorrhage was observed only in the ID location (7.2%).
Conclusion
In Korean patients, PC-ID, especially ID vertebral artery, was the most common location of SCAD, and most cases were accompanied by an aneurysm. It also suggested that these location trends differ by population or ethnicity.

Keyword

Dissection; Stroke; Internal carotid artery dissection; Vertebral artery dissection; Dissecting aneurysm

Figure

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  Fig. 1. Flow chart of the dissection analysis and comparison with other studies. CTA, computed tomography angiography; MRA, magnetic resonance angiography; MRI, magnetic resonance imaging; DSA, digital subtraction angiography; AC, anterior circulation; PC, posterior circulation; ID, intradural; ED extradural. *Number of patients undergoing each modality.

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  Fig. 2. Pie charts showing the differences of lesion locations among three studies according to the presenting and morphological patterns. The sizes of the circles reflect the number of patients in each group. The sector of the circle is marked with different colors according to the proportional patient number of each morphological pattern; the numbers of “aneurysm” and “steno-occlusion” do not include the numbers of “combined” cases. The pie charts of Japanese and European studies do not have colors because a detailed analysis of presenting patterns could not be done.

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