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Seven patients had precipitating events within 24 h of onset of symptoms that may have been causative of dissection and five had hypertension.At catheter angiography,two patients had dissections in two arteries(both VAs in one patient,VA and internal carotid artery in one patient),giving a total of 15 VAs with dissection.Dissection sites included V1 in four patients,V2 in one patient,V3 in three patients,V4 in six patients,and both V3 and V4 in one patient.Luminal stenosis was present in 13 VAs, occlusion in 2,pseudoaneurysm in 1,and evidence of fibromuscular dysplasia in 1.Posterior circulation infarcts were found on CT or MR in five patients.Subarachnoid hemorrhage was found on CT in two patients and by lumbar puncture along in two patients.Abnormal periarterial signal on MRI was seen in three patients.MRA demonstrated absent VA signal in one patient,pseudoaneurysm in one,and a false-negative examination in one. Repeat catheter angiography of nine VAs at an interval ranging from 2 weeks to 1 year showed progression to occlusion in two arteries,unchanged appearance in 4,and angiographic resolution in three,which did not closely correlate with clinical outcome.No preferred site of dissection along the course of the VA was found in this study.CT and MR examinations of the head are frequently normal in patients with VA dissections.No correlation between clinical outcome and findings at repeat angiography was demonstrated. |
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angiography,vertebral artery
arterial dissection
arterial dissection,vertebral
CAT scan
CAT scan,abnormal
CAT scan,false negative
MRI
MRI,abnormal
MRI,angiography
MRI,false negative
vertebral artery
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