Arterial dissection as a cause of intracranial stenosis: A narrative review

•Intracranial artery dissection is a non-atherosclerotic rare cause of stroke.•Frequent in the middle cerebral artery and supraclinoid portion of internal carotid.•Radiology findings: Intimal flap, double lumen, intramural hematoma, pseudo-aneurysma.•Hypertension, connective tissue disease and migra...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2020-03, Vol.190, p.105653-105653, Article 105653
Main Authors: Montalvan, V., Ulrich, A., Wahlster, S., Galindo, D.
Format: Article
Language:English
Subjects:
Age
Anticoagulants
Arterial stenosis
Arteriosclerosis
Atherosclerosis
Cardiovascular system
Carotid arteries
Clinical trials
Dissection
Epidemiology
Hematoma
Hemorrhage
Hypertension
Intracranial
Intracranial artery dissection
Ischemia
Medical imaging
Migraine
Morbidity
Neurology
Risk factors
Stenosis
Stroke
Subarachnoid hemorrhage
Thromboembolism
Veins & arteries
Young adults
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Summary:•Intracranial artery dissection is a non-atherosclerotic rare cause of stroke.•Frequent in the middle cerebral artery and supraclinoid portion of internal carotid.•Radiology findings: Intimal flap, double lumen, intramural hematoma, pseudo-aneurysma.•Hypertension, connective tissue disease and migraine are important risk factors.•Therapy with antiplatelets or anticoagulants is still the mainstay of treatment. Intracranial artery dissection (IAD) is an underdiagnosed, non-atherosclerotic cause of stroke with various clinical manifestations. To identify all the potential studies investigating the epidemiology, risk factors, symptoms, radiology findings, and treatment methods of IAD, we conducted a literature search screening PubMed, SCOPUS, EMBASE, and BIREME. According to the results of several studies, IAD is the major cause of ischemic stroke in at least one-third of the cervical-cranial artery dissection (CCAD) cases presenting with ischemic stroke. Mechanical causes are associated with cervical artery dissections (CAD) in up to 40 % of the cases. However, the risk factors for IAD are still not completely understood. Antithrombotic therapy with either antiplatelet or classic anticoagulants is the mainstay of treatment for preventing further thromboembolic complication after a stroke. Endovascular or surgical treatment options can be considered when medical therapies are not effective or when there is a high rate of recurrence or increased risk of bleeding. The observational studies have shown that these methods are very effective in preventing recurrence and significantly improving morbidity and mortality in patients with ruptured dissections. Clinical trials are required to establish the best option for each mechanism of ischemic lesion.
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2019.105653