Clinical Features, Approach And Prognosis In Spontaneous Craniocervical Artery Dissections


Thesis Type: Expertise In Medicine

Institution Of The Thesis: Gazi Üniversitesi, Tıp Fakültesi, Turkey

Approval Date: 2020

Thesis Language: Turkish

Student: ÜLVİYE ÇİĞDEM ÇEK

Supervisor: HALE ZEYNEP BATUR ÇAĞLAYAN

Abstract:

Craniocervical Artery Dissections (CAD) represent one of the major causes of non-atherosclerotic stroke in young and have lower mortality and morbidity rates. The diagnosis of CAD has been facilitated by the widespread use of modern high-resolution radiological imaging techniques. In the present study, sixty-seven patients with CAD (intracranial and extracranial) were evaluated for demographic features, clinical presentations, risk factors, imaging findings, treatment and the influence of these factors on prognosis and vascular healing (recanalization) of the dissection were assessed. Although Internal Carotid Artery Dissections (ICAD) and Vertebral Artery Dissections (VAD) have different demographic features, clinical presentations and risk factors; the current literature informs that they have similar prognosis and same treatment strategies. Our study demonstrated CAD has a favorable prognosis with rare recurrent ischemic infarcts (%2,9), lower hemorrhage complications (%2,9). Additionally, intracranial artery dissections had the same favorable outcome as extracranial artery dissections. Motor weakness and impaired consciousness were the symptoms which have significantly higher modified Rankin Score (mRS) at the third month (as a measure of functional outcome) and these symptoms were correlated with poor prognosis. Our study demonstrated the antiplatelet and anticoagulant medications are equal in efficiency and have similar protection for recurrent dissection and ischemic episodes. Endovascular treatment protocols were found to be beneficial for selected patients, considering the possible complications. Finally, our study supported previous studies in literature that suggesting treatment option does not affect spontaneous recanalization and spontaneous recanalization is not associated with prognosis and morbidity.