Strokes due to Vertebral and Carotid Artery Dissections a comparative study

Abstract

Background and Objective: Arterial dissection is an important etiology of stroke in the young. This study was done to compare the risk factors and long-term outcomes following stroke due to vertebral and carotid artery dissections.

Methods: A retrospective cohort study was conducted. The data was collected through the electronic medical record and they were followed up at discharge, at 3 months and 6 months after the stroke.

Result: The study period was between 01/01/2011 to 01/01/2018. There were 4131 cases of strokes. among which 1756 (42.5%) were ischemic strokes. Among the ischemic stroke 39 (2.2 %) were due to dissection. The mean age was 30.68 (12.2) years and 36.42 (10.15) years among VAD and CAD respectively. There was male preponderance (87.2%) in both groups. Trauma was the most common predisposing factor seen among 38.9 % and 38.1% of the VAD and CAD respectively while headache and neck pain were the common initial symptoms.  Multimodal imaging technique was needed to confirm the diagnosis of dissection in > 50%. The VAD cohort appears to have a better outcome with 57.3% achieving a modified Rankin Score of </=2 at 6 months compared with only 29.4% in the CAD cohort.

Conclusion: The clinical presentation and etiology were similar in CAD and VAD. In suspected cases of both VAD and CAD multimodal imaging technique may be needed for confirming diagnosis. VAD appears to have better long-term outcome compared to CAD.

Keywords:

CAD: Carotid Artery Dissection

MRs: Modified Rankin Score

VAD: Vertebral Artery Dissection