(Stroke. 1996;27:1226-1230.)
© 1996 American Heart Association, Inc.
Articles |
Transcranial Doppler in the Evaluation of Internal Carotid Artery Dissection
the Department of Neurological Surgery, University of Washington School of Medicine, Seattle; and the Department of Neurology, University of Bern (Switzerland) (M.S.).
Correspondence to David W. Newell, MD, Department of Neurological Surgery, University of Washington School of Medicine, Box 359766, Seattle, WA 98104.
Background and Purpose A subject with dissection of the internal carotid artery (ICA) may present with a variety of symptoms, from headache to stroke. Thus far, it has not been possible to identify the subset of patients at risk for cerebral ischemia. Because the majority of these ischemic events are secondary to embolic phenomena, we used transcranial Doppler (TCD) evaluation with emboli monitoring to study 17 consecutive patients with ICA dissection treated at Harborview Medical Center, Seattle, Wash, during a 2-year period from 1992 until 1994.
Methods Ten patients with ICA dissection secondary to trauma and seven with spontaneous ICA dissection were diagnosed by carotid angiography and studied by TCD from the time of diagnosis through initiation of therapy. Emboli monitoring was performed in the middle cerebral artery (MCA) ipsilateral to the dissection at the initial evaluation and intermittently thereafter to ensure that the emboli stopped with treatment.
Results Emboli were detected in the MCA distal to the dissection in 10 of 17 patients (59%). Patients with microemboli detected by TCD presented with a stroke (70%) much more frequently than those without emboli (14%) (P=.0498). The presence of a pseudoaneurysm did not increase the risk of either microemboli or stroke.
Conclusions We have demonstrated a high incidence of intracranial microemboli in the MCA distal to carotid dissections and a significant correlation between the presence of emboli and stroke. TCD can therefore be used as an adjunctive tool to manage patients with suspected carotid dissection and may prove useful in evaluating the efficacy of treatment in reducing microemboli and subsequent stroke.
Key Words: anticoagulation • dissection • stroke • ultrasonics
This article has been cited by other articles:
 |
|
 |
|
  S. T. Engelter, T. Brandt, S. Debette, V. Caso, C. Lichy, A. Pezzini, S. Abboud, A. Bersano, R. Dittrich, C. Grond-Ginsbach, et al. Antiplatelets Versus Anticoagulation in Cervical Artery Dissection Stroke, September 1, 2007; 38(9): 2605 - 2611. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. Lee, S. W. Yong, O. Y. Bang, Y. S. Shin, B. M. Kim, and S. Y. Kim Comparison of Spontaneous Intracranial Vertebral Artery Dissection With Large Artery Disease Arch Neurol, December 1, 2006; 63(12): 1738 - 1744. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. H. Lee, R. D. Brown Jr, J. N. Mandrekar, and B. Mokri Incidence and outcome of cervical artery dissection: A population-based study Neurology, November 28, 2006; 67(10): 1809 - 1812. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.Y. Ahn, I.B. Han, T.G. Kim, P.H. Yoon, Y.J. Lee, B.-H. Lee, S.H. Seo, D.I. Kim, C.K. Hong, and J.Y. Joo Endovascular Treatment of Intracranial Vertebral Artery Dissections with Stent Placement or Stent-assisted Coiling AJNR Am. J. Neuroradiol., August 1, 2006; 27(7): 1514 - 1520. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Tola, M. Yurdakul, and T. Cumhur B-Flow Imaging in Low Cervical Internal Carotid Artery Dissection J. Ultrasound Med., November 1, 2005; 24(11): 1497 - 1502. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Norris Extracranial Arterial Dissection: Anticoagulation Is the Treatment of Choice: For Stroke, September 1, 2005; 36(9): 2041 - 2042. [Full Text] [PDF]
|
|
|
|
 |
|
 B Thanvi, S K Munshi, S L Dawson, and T G Robinson Carotid and vertebral artery dissection syndromes Postgrad. Med. J., June 1, 2005; 81(956): 383 - 388. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Neri, G. Sani, M. Massetti, G. Frati, D. Buklas, R. Tassi, M. Giubbolini, A. Benvenuti, and C. Sassi Residual dissection of the brachiocephalic arteries: Significance, management, and long-term outcome J. Thorac. Cardiovasc. Surg., August 1, 2004; 128(2): 303 - 312. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. Cohen, R. R. Leker, M. Gotkine, M. Gomori, and T. Ben-Hur Emergent Stenting to Treat Patients With Carotid Artery Dissection: Clinically and Radiologically Directed Therapeutic Decision Making Stroke, December 1, 2003; 34 (12): e254 - e257. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Beletsky, Z. Nadareishvili, J. Lynch, A. Shuaib, A. Woolfenden, and J. W. Norris Cervical Arterial Dissection: Time for a Therapeutic Trial? Stroke, December 1, 2003; 34(12): 2856 - 2860. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. Cohen, J. M. Gomori, and F. Umansky Endovascular Management of Spontaneous Bilateral Symptomatic Vertebral Artery Dissections AJNR Am. J. Neuroradiol., November 1, 2003; 24(10): 2052 - 2056. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Arnold, K. Nedeltchev, M. Sturzenegger, G. Schroth, T. J. Loher, F. Stepper, L. Remonda, C. Bassetti, and H. P. Mattle Thrombolysis in Patients With Acute Stroke Caused by Cervical Artery Dissection: Analysis of 9 Patients and Review of the Literature Arch Neurol, April 1, 2002; 59(4): 549 - 553. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. I. Schievink Spontaneous Dissection of the Carotid and Vertebral Arteries N. Engl. J. Med., March 22, 2001; 344(12): 898 - 906. [Full Text] [PDF]
|
|
|
|
|
|
C. A. Molina, J. Alvarez-Sabin, W. Schonewille, J. Montaner, A. Rovira, S. Abilleira, and A. Codina Cerebral microembolism in acute spontaneous internal carotid artery dissection Neurology, December 12, 2000; 55(11): 1738 - 1741. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-C. Koennecke and S. Seyfert Mydriatic Pupil as the Presenting Sign of Common Carotid Artery Dissection Stroke, December 1, 1998; 29(12): 2653 - 2655. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. B Blunt and C. Galton Cervical carotid or vertebral artery dissection BMJ, January 25, 1997; 314(7076): 243 - 243. [Full Text]
|
|