Abstract：
OBJECTIVE: To explore the factors associated with ischemic stroke secondary to spontaneous cervicocranial artery dissection (sCCAD) and evaluate the initial imaging markers related to outcomes.
METHODS: Initial and follow-up high-resolution vessel wall MRI (VW-MRI) in consecutive patients with sCCAD were retrospectively analyzed. The associations of clinical and imaging factors and variants of the circle of Willis (COW) with ischemic stroke were evaluated using binary logistic regression analyses. The anatomical outcomes were categorized as complete, partial, and no remodeling based on changes of the vessel wall and lumen. Ordinal logistic regression analysis was used to assess associations between initial features and outcomes.
RESULTS: A total of 115 dissected arteries (79 strokes, 36 non-strokes) were detected in 103 patients. Follow-up VW-MRI was available in 46 patients (44.7%, with 51 vessels), with a median interval of 8.5 months. Pseudoaneurysm (odd ratio [OR], 0.178; 95% confidence interval [CI], 0.039-0.810; p = 0.026) tended to rarely cause ischemic stroke, while intraluminal thrombus (OR, 5.558; 95% CI, 1.739-17.765; p = 0.004), incomplete COW (OR, 9.309; 95% CI, 2.122-40.840; p = 0.003), and partial complete COW (OR, 4.463; 95% CI, 1.211-16.453; p = 0.025) were independently associated with stroke occurrence. Furthermore, the presence of double lumen (OR, 5.749; 95% CI, 1.358-24.361; p = 0.018) and occlusion (OR, 12.975; 95% CI, 3.022-55.645; p = 0.001) were associated with no remodeling of sCCAD.
CONCLUSIONS: Multiple initial factors were found to be related to stroke occurrence and anatomical outcomes of sCCAD. High-resolution VW-MRI may provide valuable insights into the pathophysiology and evolution of sCCAD.
CONCLUSIONS: Initial and follow-up high-resolution vessel wall MRI may help elucidate the pathophysiology of spontaneous cervicocranial artery dissection and provide important insights into the evolution and further facilitate the optimal management of patients with spontaneous cervicocranial artery dissection.
CONCLUSIONS: • Clinical and imaging factors, as well as the status of primary collateral circulation, are associated with ischemic stroke secondary to spontaneous cervicocranial artery dissection. • The follow-up high-resolution vessel wall MRI provides valuable insights into the long-term evolution and anatomical outcomes of spontaneous cervicocranial artery dissection. • The high-resolution vessel wall MRI features related to ischemic stroke and anatomical outcomes may further facilitate the optimal management of patients with spontaneous cervicocranial artery dissection.
METHODS: Initial and follow-up high-resolution vessel wall MRI (VW-MRI) in consecutive patients with sCCAD were retrospectively analyzed. The associations of clinical and imaging factors and variants of the circle of Willis (COW) with ischemic stroke were evaluated using binary logistic regression analyses. The anatomical outcomes were categorized as complete, partial, and no remodeling based on changes of the vessel wall and lumen. Ordinal logistic regression analysis was used to assess associations between initial features and outcomes.
RESULTS: A total of 115 dissected arteries (79 strokes, 36 non-strokes) were detected in 103 patients. Follow-up VW-MRI was available in 46 patients (44.7%, with 51 vessels), with a median interval of 8.5 months. Pseudoaneurysm (odd ratio [OR], 0.178; 95% confidence interval [CI], 0.039-0.810; p = 0.026) tended to rarely cause ischemic stroke, while intraluminal thrombus (OR, 5.558; 95% CI, 1.739-17.765; p = 0.004), incomplete COW (OR, 9.309; 95% CI, 2.122-40.840; p = 0.003), and partial complete COW (OR, 4.463; 95% CI, 1.211-16.453; p = 0.025) were independently associated with stroke occurrence. Furthermore, the presence of double lumen (OR, 5.749; 95% CI, 1.358-24.361; p = 0.018) and occlusion (OR, 12.975; 95% CI, 3.022-55.645; p = 0.001) were associated with no remodeling of sCCAD.
CONCLUSIONS: Multiple initial factors were found to be related to stroke occurrence and anatomical outcomes of sCCAD. High-resolution VW-MRI may provide valuable insights into the pathophysiology and evolution of sCCAD.
CONCLUSIONS: Initial and follow-up high-resolution vessel wall MRI may help elucidate the pathophysiology of spontaneous cervicocranial artery dissection and provide important insights into the evolution and further facilitate the optimal management of patients with spontaneous cervicocranial artery dissection.
CONCLUSIONS: • Clinical and imaging factors, as well as the status of primary collateral circulation, are associated with ischemic stroke secondary to spontaneous cervicocranial artery dissection. • The follow-up high-resolution vessel wall MRI provides valuable insights into the long-term evolution and anatomical outcomes of spontaneous cervicocranial artery dissection. • The high-resolution vessel wall MRI features related to ischemic stroke and anatomical outcomes may further facilitate the optimal management of patients with spontaneous cervicocranial artery dissection.
摘要：
目的：探讨自发性颈颅动脉夹层（sCCAD）继发缺血性卒中的相关因素，并评估与预后相关的初始影像学指标。
方法：回顾性分析连续sCCAD患者的初始和随访高分辨率血管壁MRI（VW-MRI）。使用二元逻辑回归分析评估临床和影像学因素以及威利斯环（COW）变异与缺血性卒中的相关性。解剖结果被归类为完整，局部,并且没有基于血管壁和管腔变化的重塑。序数逻辑回归分析用于评估初始特征和结果之间的关联。
结果：共有115个解剖动脉（79个中风，在103例患者中检测到36例非中风）。46例患者（44.7%，有51艘船)，中位间隔为8.5个月。假性动脉瘤（奇数比[OR]，0.178；95%置信区间[CI]，0.039-0.810；p=0.026）倾向于很少引起缺血性中风，而管腔内血栓（OR，5.558；95%CI，1.739-17.765；p=0.004），不完整的牛(或，9.309；95%CI，2.122-40.840；p=0.003），和部分完整的牛(或，4.463；95%CI，1.211-16.453；p=0.025）与卒中发生独立相关。此外，双腔的存在(或，5.749；95%CI，1.358-24.361；p=0.018）和闭塞（OR，12.975；95%CI，3.022-55.645；p=0.001）与sCCAD无重塑相关。
结论：发现多种初始因素与sCCAD的卒中发生和解剖结果相关。高分辨率VW-MRI可能为sCCAD的病理生理学和演变提供有价值的见解。
结论：初始和后续高分辨率血管壁MRI可能有助于阐明自发性颈颅动脉夹层的病理生理学，并提供对演变的重要见解，并进一步促进自发性颈颅动脉夹层患者的最佳治疗。
结论：•临床和影像学因素，以及初级抵押品流通的状况，与自发性颈颅动脉夹层继发的缺血性卒中有关。•后续高分辨率血管壁MRI为自发性颈颅动脉夹层的长期演变和解剖学结果提供了有价值的见解。•与缺血性卒中和解剖学结果相关的高分辨率血管壁MRI特征可能进一步促进自发性颈颅动脉夹层患者的最佳治疗。
方法：回顾性分析连续sCCAD患者的初始和随访高分辨率血管壁MRI（VW-MRI）。使用二元逻辑回归分析评估临床和影像学因素以及威利斯环（COW）变异与缺血性卒中的相关性。解剖结果被归类为完整，局部,并且没有基于血管壁和管腔变化的重塑。序数逻辑回归分析用于评估初始特征和结果之间的关联。
结果：共有115个解剖动脉（79个中风，在103例患者中检测到36例非中风）。46例患者（44.7%，有51艘船)，中位间隔为8.5个月。假性动脉瘤（奇数比[OR]，0.178；95%置信区间[CI]，0.039-0.810；p=0.026）倾向于很少引起缺血性中风，而管腔内血栓（OR，5.558；95%CI，1.739-17.765；p=0.004），不完整的牛(或，9.309；95%CI，2.122-40.840；p=0.003），和部分完整的牛(或，4.463；95%CI，1.211-16.453；p=0.025）与卒中发生独立相关。此外，双腔的存在(或，5.749；95%CI，1.358-24.361；p=0.018）和闭塞（OR，12.975；95%CI，3.022-55.645；p=0.001）与sCCAD无重塑相关。
结论：发现多种初始因素与sCCAD的卒中发生和解剖结果相关。高分辨率VW-MRI可能为sCCAD的病理生理学和演变提供有价值的见解。
结论：初始和后续高分辨率血管壁MRI可能有助于阐明自发性颈颅动脉夹层的病理生理学，并提供对演变的重要见解，并进一步促进自发性颈颅动脉夹层患者的最佳治疗。
结论：•临床和影像学因素，以及初级抵押品流通的状况，与自发性颈颅动脉夹层继发的缺血性卒中有关。•后续高分辨率血管壁MRI为自发性颈颅动脉夹层的长期演变和解剖学结果提供了有价值的见解。•与缺血性卒中和解剖学结果相关的高分辨率血管壁MRI特征可能进一步促进自发性颈颅动脉夹层患者的最佳治疗。
