(Stroke. 1996;27:1804-1807.)
© 1996 American Heart Association, Inc.
Articles |
Recurrence of Cervical Artery Dissection
A Prospective Study of 81 Patients
the Departments of Neurology and Radiology (E.T.), University Hospital, Inselspital, Bern, Switzerland.
Correspondence to C. Bassetti, MD, Department of Neurology, Inselspital, 3010 Bern, Switzerland.
Background and Purpose Spontaneous cervical artery dissection (SCAD) is a common cause of stroke in the young; however, its recurrence has been rarely studied. Recurrent SCAD at the level of the previously dissected vessel has been reported in only six patients.
Methods We prospectively evaluated and followed a series of 81 patients seen in our center with carotid (n=66) or vertebral (n=15) artery dissection, in whom the diagnosis was confirmed by angiography, MRI, or both. Repeated clinical and ultrasound examinations were performed in all patients during a mean follow-up of 34 months (range, 12 to 57 months).
Results Three patients died of the consequences of stroke, and four patients were unavailable for follow-up. Three of the remaining 74 patients (4%) had a recurrent carotid dissection while under prophylaxis with aspirin (n=2) or anticoagulation (n=1). None of the patients had a recurrent vertebral dissection. Recurrent carotid dissection occurred 16 months to 4 years after the first episode and presented with acute head and neck pain (n=2) and hemispheric transient ischemic attack (n=1). In one patient recurrence was documented by Doppler and MRI at the level of the first dissection.
Conclusions We confirm that recurrence of SCAD is uncommon and usually represents a benign condition. Delayed recurrence seems to be more common than previously suggested and can occur at the level of the previously dissected vessel.
Key Words: carotid arteries • dissection • vertebral artery
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