Sonographic Features of Craniocervical Artery Dissection

Acta Clinica Croatica; Vol.41 No.4
Source: OAI

ABSTRACT Craniocervical artery dissection (CCAD) is primarily diagnosed by angiography, brain magnetic resonance (MR) or MR angiography. Color Doppler flow imaging (CDFI) has been underrated due to the localization of dissection, which appears to be most commonly localized intracranially. Nevertheless, dissection may manifest in various ways, enabling CDFI to present a broad spectrum of findings. The aim of this study was to analyze ultrasonographic findings in patients with clinical or ultrasonographic presentation of CCAD. Forty-three patients who presented with CCAD over a two-year period were retrospectively analyzed. Twenty-three of these patients showed clinical manifestations of CCAD, whereas in 19 patients ultrasound revealed double lumen or bifurcation stenosis with double lumen. Carotid and vertebral CDFI was performed on an Acuson 128 XP device. Color and power Doppler scans and hemodynamic spectra were analyzed. Data are presented descriptively. Data on 43 patients (28 male and 15 female, mean age 59±11 years) were analyzed. There were 49 ultrasonographically detected dissected vessels (37 carotid, 10 vertebral and 2 subclavian arteries). A string sign was found in 5 patients (5 internal carotid arteries (ICA)), string and pearl sign in 2 patients (1 ICA and 1 vertebral artery (VA)), subintimal flow in one patient (1 ICA), double lumen in 12 patients (3 common carotid arteries (CCA), 7 ICA, 3 VA and 2 subclavian arteries); one patient presented as VA dissection and subarachnoid hemorrhage (SAH; ICA dissection on ultrasonography); carotid stenosis with double lumen under the plaque base was found in 17 patients (2 ACC, 13 bifurcation stenoses, and 2 ICA stenoses with dissection under the plaque base); hemodynamic spectra suggesting distal occlusion were detected in 8 patients (3 ICA, 6 VA); and multiple vessel involvement was present in 7 (16%) patients. Ultrasound can show a broad spectrum of findings in CCAD including direct evidence for intimal flap and detectable subintimal flow as well as signs of hemodynamically significant flow obstruction.

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