Lin Xuehua, Guo Wei, She Dejun, Kang Yaqing, Xing Zhen, Cao Dairong
Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China.
Department of Radiology, Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian, China.
Eur Radiol. 2024 Mar;34(3):1704-1715. doi: 10.1007/s00330-023-10207-z. Epub 2023 Sep 5.
To explore the factors associated with ischemic stroke secondary to spontaneous cervicocranial artery dissection (sCCAD) and evaluate the initial imaging markers related to outcomes.
Initial and follow-up high-resolution vessel wall MRI (VW-MRI) in consecutive patients with sCCAD were retrospectively analyzed. The associations of clinical and imaging factors and variants of the circle of Willis (COW) with ischemic stroke were evaluated using binary logistic regression analyses. The anatomical outcomes were categorized as complete, partial, and no remodeling based on changes of the vessel wall and lumen. Ordinal logistic regression analysis was used to assess associations between initial features and outcomes.
A total of 115 dissected arteries (79 strokes, 36 non-strokes) were detected in 103 patients. Follow-up VW-MRI was available in 46 patients (44.7%, with 51 vessels), with a median interval of 8.5 months. Pseudoaneurysm (odd ratio [OR], 0.178; 95% confidence interval [CI], 0.039-0.810; p = 0.026) tended to rarely cause ischemic stroke, while intraluminal thrombus (OR, 5.558; 95% CI, 1.739-17.765; p = 0.004), incomplete COW (OR, 9.309; 95% CI, 2.122-40.840; p = 0.003), and partial complete COW (OR, 4.463; 95% CI, 1.211-16.453; p = 0.025) were independently associated with stroke occurrence. Furthermore, the presence of double lumen (OR, 5.749; 95% CI, 1.358-24.361; p = 0.018) and occlusion (OR, 12.975; 95% CI, 3.022-55.645; p = 0.001) were associated with no remodeling of sCCAD.
Multiple initial factors were found to be related to stroke occurrence and anatomical outcomes of sCCAD. High-resolution VW-MRI may provide valuable insights into the pathophysiology and evolution of sCCAD.
Initial and follow-up high-resolution vessel wall MRI may help elucidate the pathophysiology of spontaneous cervicocranial artery dissection and provide important insights into the evolution and further facilitate the optimal management of patients with spontaneous cervicocranial artery dissection.
• Clinical and imaging factors, as well as the status of primary collateral circulation, are associated with ischemic stroke secondary to spontaneous cervicocranial artery dissection. • The follow-up high-resolution vessel wall MRI provides valuable insights into the long-term evolution and anatomical outcomes of spontaneous cervicocranial artery dissection. • The high-resolution vessel wall MRI features related to ischemic stroke and anatomical outcomes may further facilitate the optimal management of patients with spontaneous cervicocranial artery dissection.
探讨自发性颈颅动脉夹层（sCCAD）继发缺血性卒中的相关因素，并评估与预后相关的初始影像标志物。
对连续的sCCAD患者的初始和随访高分辨率血管壁MRI（VW-MRI）进行回顾性分析。采用二元逻辑回归分析评估临床和影像因素以及 Willis 环（COW）变异与缺血性卒中的相关性。根据血管壁和管腔的变化，将解剖学结果分为完全重塑、部分重塑和无重塑。采用有序逻辑回归分析评估初始特征与预后之间的关联。
103例患者共检测到115条夹层动脉（79例卒中，36例未发生卒中）。46例患者（44.7%，共51条血管）有随访VW-MRI，中位随访间隔为8.5个月。假性动脉瘤（比值比[OR]，0.178；95%置信区间[CI]，0.039 - 0.810；p = 0.026）很少导致缺血性卒中，而管腔内血栓（OR，5.558；95% CI，1.739 - 17.765；p = 0.004）、COW不完整（OR，9.309；95% CI，2.122 - 40.840；p = 0.003）和部分完整COW（OR，4.463；95% CI，1.211 - 16.453；p = 0.025）与卒中发生独立相关。此外，双腔的存在（OR，5.749；95% CI，1.358 - 24.361；p = 0.018）和闭塞（OR，12.975；95% CI，3.022 - 55.645；p = 0.001）与sCCAD无重塑相关。
发现多个初始因素与sCCAD的卒中发生及解剖学结果相关。高分辨率VW-MRI可能为sCCAD的病理生理学及演变提供有价值的见解。
初始和随访高分辨率血管壁MRI可能有助于阐明自发性颈颅动脉夹层的病理生理学，为其演变提供重要见解，并进一步促进自发性颈颅动脉夹层患者的优化管理。
• 临床和影像因素以及主要侧支循环状态与自发性颈颅动脉夹层继发缺血性卒中相关。• 随访高分辨率血管壁MRI为自发性颈颅动脉夹层的长期演变和解剖学结果提供有价值的见解。• 与缺血性卒中和解剖学结果相关的高分辨率血管壁MRI特征可能进一步促进自发性颈颅动脉夹层患者的优化管理。
