Abstract WMP68: Clinical and Radiological Characteristics of Intracranial Artery Dissection Using Recently Proposed Diagnostic Criteria

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Background and purpose: A group of international experts on intracranial artery dissection (IAD) recently reported a consensus statement and criteria about the diagnosis of IAD (Debette S, et al: Lancet Neurol 2015). But there are little data showing clinical features of IAD based on the new criteria. We aimed to elucidate clinical and radiological characteristics based on the criteria.Methods: Patients with suspected IAD were retrospectively enrolled using a prospective single-center stroke registry between 2011 and 2016. Baseline characteristics and radiological findings including conventional MRI sequences, MRA, 3D-T1 weighted TSE blood black (3DT1BB) sequence and digital subtraction angiography (DSA) were reviewed.Results: Of 147 patients with suspected IAD, 63 patients (15 women; mean age, 51±12 years) finally met the criteria of definite (n=47), probable (n=14) or possible (n=2) idiopathic IAD. Thirty-five (56 %) had a history of hypertension, 21 (33 %) had dyslipidemia, and 39 (62 %) had smoking habit. Ischemic stroke alone was found in 50 %, subarachnoid hemorrhage plus ischemic stroke in 6 %, TIA in 3 %, and head or neck pain alone in 41 % on admission. Vertebral artery was affected in 66 %, basilar artery in 2 %, posterior inferior cerebral artery in 5 %, anterior cerebral artery in 11 %, middle cerebral artery in 6 %, intracranial internal carotid artery in 2 % and multi-vessels in 8 %. Intimal flap, double lumen and aneurysmal dilatation were similarly observed between 3DT1BB and MRI/MRA/DSA. Intramural hematoma was more frequently detected in 3DT1BB sequence than conventional MRI/MRA (initial image, 53 % vs. 14 %, P < 0.001; follow-up image, 59 % vs. 22 %, P < 0.001). Follow-up image was essential to fulfill the criteria in 12 patients; rapid morphological change of aneurysmal dilation in 3, a newly detection of intramural hematoma in 3, double lumen in 2, pearl and string sign in 2, and aneurysmal dilation without change in morphology in 2 on follow-up images. Modified Rankin Scale score of ≤ 1 at 90 days was observed in 54 patients (86 %).Conclusions: Intracranial vertebral artery was most frequently affected. 3DT1BB sequence was apparently useful in detecting intraluminal hematoma in the recently proposed diagnostic criteria of idiopathic IAD.

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