Document Detail


R2-recanalization of spontaneous carotid artery dissection.
MedLine Citation:
PMID:  19109549     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: We set out to investigate the predictors and time course for recanalization of spontaneous dissection of the cervical internal carotid artery (SICAD). METHODS: We prospectively included 249 consecutive patients (mean age, 45+/-11 years) with 268 SICAD. Ultrasound examinations were performed at presentation, during the first month, and then at 3, 6, and 12 months, and clinical follow-ups after 3, 6, and 12 months. RESULTS: Of 268 SICADs, 20 (7.5%) presented with <or=50% stenosis, 31 (11.6%) with 51% to 80% stenosis, 92 (34.3%) with 81% to 99% stenosis, and 125 (46.6%) with an occlusion. Antithrombotic treatment included anticoagulation in 174 (67%) patients, aspirin in 64 (24%) patients, and aspirin followed by anticoagulation or vice versa in 22 (8%) patients. Follow-up ultrasound showed normal findings in 160 (60%), <or=50% stenosis in 27 (10%), 51% to 80% stenosis in 4 (1%), 81% to 99% stenosis in 26 (10%), and occlusion in 51 (19%) vessels. The rate of complete recanalization was 16% at 1 month, 50% at 3 months, and 60% at 6 and 12 months. Initial occlusion of the dissected vessels reduced the odds of recanalization (OR, 4.0; 95% CI, 2.2-7.3; P<0.001), whereas the occurrence of local symptoms and signs only at presentation were independently associated with complete recanalization (OR, 0.4; 95% CI, 0.2-0.8; P=0.048). CONCLUSIONS: These results suggest that recanalization of SICAD occurs mainly within the first 6 months after the onset of symptoms. Initial occlusion reduces the likelihood of complete recanalization, whereas presentation with local symptoms and signs only increases it.
Authors:
Krassen Nedeltchev; Stefan Bickel; Marcel Arnold; Hakan Sarikaya; Dimitrios Georgiadis; Matthias Sturzenegger; Heinrich P Mattle; Ralf W Baumgartner
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-12-24
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  40     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-27     Completed Date:  2009-02-20     Revised Date:  2009-10-28    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  499-504     Citation Subset:  IM    
Affiliation:
Department of Neurology, University Hospital, Zürich, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anticoagulants / therapeutic use
Carotid Artery, Internal, Dissection / drug therapy,  pathology*,  ultrasonography
Carotid Stenosis / pathology,  ultrasonography
Female
Fibrinolytic Agents / therapeutic use
Follow-Up Studies
Humans
Male
Middle Aged
Neovascularization, Pathologic / drug therapy,  pathology*,  ultrasonography
Prospective Studies
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents
Comments/Corrections
Comment In:
Stroke. 2009 Nov;40(11):e629; author reply e630-1   [PMID:  19762708 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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