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.