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Abstract
Objective To compare the outcomes between patients with nontraumatic intracranial arterial dissection (ICAD) and intracranial atherosclerotic stenosis (ICAS) using high-resolution MRI (HR-MRI).
Methods We conducted a prospective study using HR-MRI in patients with acute symptomatic cerebrovascular disease due to intracranial occlusive disease and no dissection on luminal images. Patients were followed-up for 27.9 ± 19.3 months. We compared the functional outcome, recurrence, and changes in vascular status between patients with ICAD (dissection and no plaque on HR-MRI) and ICAS (atherosclerosis plaque on HR-MRI).
Results We included 312 patients (mean age, 59.0 ± 14.2 years; men, 58.3%), of whom 113 had ICAD and 199 had ICAS. The functional outcome (as measured by modified Rankin Scale score) on the 90th day after symptom onset was not different between the groups, after adjusted for other factors (p = 0.095). However, recurrent ischemic cerebrovascular disease on the relevant vascular territory was lower in the ICAD group (7 patients, 6.2%) than in the ICAS group (37 patients, 18.6%). ICAD was a significant independent determinant of disease recurrence (hazard ratio, 0.43; 95% confidence interval, 0.19–0.98). Improvement in vascular stenosis on follow-up vascular studies was more frequently observed in ICAD (50.7%) than in ICAS (11.6%). ICAD was an independent determinant of vascular improvement (odds ratio, 7.94; 95% confidence interval, 3.32–19.01).
Conclusion Considering the high prevalence of ICAD in the patients with presumed ICAS and the differential outcomes between ICAD and ICAS, HR-MRI may be a useful diagnostic tool in this population.
Glossary
- CI=
- confidence interval;
- FOV=
- field of view;
- HR-MRI=
- high-resolution MRI;
- ICAD=
- intracranial arterial dissection;
- ICAS=
- intracranial atherosclerotic stenosis;
- LICVD=
- large intracranial vessel disease;
- MACE=
- major adverse cardiovascular event;
- MMD=
- moyamoya disease;
- MRA=
- magnetic resonance angiography;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale;
- OR=
- odds ratio;
- RCVS=
- reversible cerebral vasoconstriction syndrome;
- SENSE=
- sensitivity encoding;
- TE=
- echo time;
- TOF=
- time-of-flight;
- TR=
- repetition time;
- VISTA=
- volume isotropic turbo spin echo acquisition
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received January 11, 2018.
- Accepted in final form July 28, 2018.
- © 2018 American Academy of Neurology
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