Neurosonographic monitoring of 105 spontaneous cervical artery dissections: a prospective study.

Abstract Objective To monitor the sonographic course of spontaneous cervical artery dissections (sCADs) and investigate their recanalization and recurrence rates. Methods All consecutive patients with an MRI-proven sCAD were prospectively evaluated by neurovascular ultrasound (nUS) daily while in hospital, then monthly for the first six months after discharge and every six months thereafter, for a mean follow-up period of 58 months (range, 28-96 months). Results One hundred and five sCADs were detected in 76 patients: 61 (58.1%) involved the internal carotid artery and 44 (41.9%) the vertebral artery, while multiple sCADs were found in four patients (5.3%). Follow-up was obtained in 74 patients (97.3%, 103 vessels). The complete and hemodynamically significant (<50% stenosis) recanalization rates were 51.4% (53/103) and 20.4% (21/103). All but one complete recanalizations occurred within the first nine months. There were early recurrences (while in hospital) in 20 previously-unaffected arteries (27%), and late recurrences in two arteries (2.7%) site of a previous sCAD. All patients (n = 6) with a family history of arterial dissection had a sCAD recurrence (four early and two late) as opposed to 16 (22.8%) among those with no known familial disease (p < .001). Conclusions These results suggest that most lumen changes occur within the first few months after the initial event, but recanalization may occur even after one year. Early recurrence is not uncommon and usually involves arteries previously unaffected by dissection, while the risk of late recurrence is low. A family history of arterial dissection is strongly associated with sCAD recurrence.