Ultrasonographic evaluation of factors leading to incomplete recanalization of cervical artery dissection

doi:10.3877/cma.j.issn.1672-6448.2019.06.001

Abstract

Abstract:

Objective

To analyze the influencing factors leading to incomplete recanalization of cervical artery dissection (CAD) by color Doppler flow imaging (CDFI).

Methods

A total of 105 patients with 126 CADs diagnosed at XuanWu Hospital, Capital Medical University from January 2014 to December 2018 were enrolled into this study. All patients were followed by CDFI at 3, 6, and 12 months after disease onset and were divided into either a complete recanalization group or an incomplete recanalization group according to the results at 12 months after the onset. The effect of factors such as age, cerebrovascular risk factors, arterial stenosis, and drug treatment on CAD recanalization were analyzed.

Results

Of the 126 dissected vessels, 54 (42.9%) were included in the incomplete recanalization group. Logistic regression analysis showed that age>45 years (OR=3.594, 95% CI: 1.430-9.033, P=0.007), history of hypertension (OR=3.037, 95% CI: 1.079-8.544, P=0.035), time from onset to treatment over one month (OR=3.135, 95% CI: 1.122-8.759, P=0.029), vascular occlusion (OR=7.381, 95% CI: 2.620-20.795, P=0.000) were independent risk factors for CAD recanalization; however, cause of CAD, extent of intramural hematoma, and anticoagulation or antiplatelet therapy were not factors affecting the incomplete recanalization of CAD (P>0.05).

Conclusion

Diagnosis and timely follow-up of CAD patients by CDFI to assess the correlation between the factors such as age, history of hypertension, timing of treatment, or stenosis of arterial lumen and recanalization are of important clinical significance.

Key words: Carotid artery diseases, Ultrasound, Doppler, Color, Risk factors

Zhaoqiang Li, Yang Hua, Lingyun Jia, Jie Yang. Ultrasonographic evaluation of factors leading to incomplete recanalization of cervical artery dissection[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(06): 401-406.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2019.06.001

https://chaosheng.cma-cmc.com.cn/EN/Y2019/V16/I06/401

Figures/Tables 3

References 28

1	Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome [J]. Lancet Neurol, 2009, 8(7): 668-678.
2	Touzé E, Gauvrit JY, Meder JF, et al. Prognosis of cervical artery dissection [J]. Front Neurol Neurosci, 2005, 20: 129-139.
3	Patel RR, Adam R, Maldjian C, et al. Cervical carotid artery dissection: current review of diagnosis and treatment [J]. Cardiol Rev, 2012, 20(3): 145-152.
4	Nedeltchev K, Bickel S, Arnold M, et al. R2-recanalization of spontaneous carotid artery dissection [J]. Stroke, 2009, 40(2): 499-504.
5	Wessels T, Mosso M, Krings T, et al. Extracranial and intracranial vertebral artery dissection: long-term clinical and duplex sonographic follow-up [J]. J Clin Ultrasound, 2008, 36(8): 472-479.
6	Baracchini C, Tonello S, Meneghetti G, et al. Neurosonographic monitoring of 105 spontaneous cervical artery dissections: a prospective study [J]. Neurology, 2010, 75(21): 1864-1870.
7	Ben Hassen W, Machet A, Edjlali-Goujon M, et al. Imaging of cervical artery dissection [J]. Diagn Interv Imaging, 2014, 95(12): 1151-1161.
8	Shakir HJ, Davies JM, Shallwani H, et al. Carotid and Vertebral Dissection Imaging [J]. Curr Pain Headache Rep, 2016, 20(12): 68.
9	Yılmaz C, Gorgulu FF, Oksuzler FY, et al. Color Doppler ultrasonography is a reliable diagnostic tool in the diagnosis of extracranial vertebral artery dissections [J]. J Med Ultrason, 2019, 46(1): 153-158.
10	McNally JS, Hinckley PJ, Sakata A, et al. Magnetic Resonance Imaging and Clinical Factors Associated With Ischemic Stroke in Patients Suspected of Cervical Artery Dissection [J]. Stroke, 2018, 49(10): 2337-2344.
11	Hanning U, Sporns PB, Schmiedel M, et al. CT versus MR Techniques in the Detection of Cervical Artery Dissection [J]. J Neuroimaging, 2017, 27(6): 607-612.
12	Robertson JJ, Koyfman A. Cervical Artery Dissections: A Review [J]. J Emerg Med, 2016, 51(5): 508-518.
13	Wang Y, Cui L, Ji X, et al. The China National Stroke Registry for patients with acute cerebrovascular events: design, rationale, and baseline patient characteristics [J]. Int J Stroke, 2011, 6(4): 355-361.
14	Arnold M, Bousser MG, Fahrni G, et al. Vertebral artery dissection: presenting findings and predictors of outcome [J]. Stroke, 2006, 37(10): 2499-2503.
15	Parmar N, Albisetti M, Berry LR, et al. The fibrinolytic system in newborns and children [J]. Clin Lab, 2006, 52(3-4): 115-124.
16	Kwaan HC. From fibrinolysis to the plasminogen-plasmin system and beyond: a remarkable growth of knowledge, with personal observations on the history of fibrinolysis [J]. Semin Thromb Hemost, 2014, 40(5): 585-591.
17	吕宝经, 郭晋村, 陆尚彪, 等. 绝经后妇女冠心病患者雌激素、凝血及纤溶系统的变化 [J].中华心血管病杂志, 2004, 32(1): 33-35.
18	司全金, 李小鹰. 老年雄激素低下患者血液凝血和纤溶系统的变化 [J]. 中华老年心脑血管病杂志, 2005, 7(3): 157-159.
19	Pezzini A, Caso V, Zanferrari C, et al. Arterial hypertension as risk factor for spontaneous cervical artery dissection. A case-control study [J]. J Neurol Neurosurg Psychiatry, 2006 , 77(1): 95-97.
20	Yaghi S, Maalouf N, Keyrouz SG. Cervical artery dissection: risk factors, treatment, and outcome; a 5-year experience from a tertiary care center [J]. Int J Neurosci, 2012, 122(1): 40-44.
21	Caso V, Paciaroni M, Corea F, et al. Recanalization of cervical artery dissection: influencing factors and role in neurological outcome [J]. Cerebrovasc Dis, 2004, 17(2-3): 93-97.
22	Ramchand P, Mullen MT, Bress A, et al. Recanalization after Extracranial Dissection: Effect of Antiplatelet Compared with Anticoagulant Therapy [J]. J Stroke Cerebrovasc Dis, 2018, 27(2): 438-444.
23	常俊森. 42例颈动脉夹层临床特点、再通随访及预后分析 [D]. 山西医科大学, 2016: 1-42.
24	Lee WJ, Jung KH, Moon J, et al. Prognosis of spontaneous cervical artery dissection and transcranial Doppler findings associated with clinical outcomes [J]. Eur Radiol, 2016, 26(5): 1284-1291.
25	Weber M, Baker MB, Moore JP, et al. MiR-21 is induced in endothelial cells by shear stress and modulates apoptosis and eNOS activity [J]. Biochem Biophys Res Commun, 2010, 393(4): 643-648.
26	Garanich JS, Pahakis M, Tarbell JM. Shear stress inhibits smooth muscle cell migration via nitric oxide-mediated downregulation of matrix metalloproteinase-2 activity [J]. Am J Physiol Heart Circ Physiol, 2005, 288(5): 2244-2252.
27	Cheng C, Tempel D, van Haperen R, et al. Atherosclerotic lesion size and vulnerability are determined by patterns of fluid shear stress [J]. Circulation, 2006, 113(23): 2744-2753.
28	Ni CW, Qiu H, Jo H. MicroRNA-663 upregulated by oscillatory shear stress plays a role in inflammatory response of endothelial cells [J]. Am J Physiol Heart Circ Physiol, 2011, 300(5): 1762-1769.

因素	完全再通组（72例）	不全再通组（54例）	χ²值	P值
年龄>45岁	12（16.7）	25（46.3）	13.060	0.000
男性	38（52.8）	35（64.8）	1.835	0.176
高血压	9（12.5）	17（31.5）	6.789	0.009
糖尿病	5（6.9）	6（11.1）	0.672	0.412
高脂血症	7（9.7）	11（20.4）	2.857	0.091
吸烟	18（25.0）	20（37.0）	2.123	0.145
继发性夹层	55（76.4）	36（66.7）	1.454	0.228
就诊距发病时间>30 d	9（12.5）	16（29.6）	5.693	0.017
夹层长段病变	50（69.4）	34（63.0）	0.583	0.445
管腔闭塞	7（9.7）	22（40.7）	16.756	0.000
抗血小板治疗	45（62.5）	34（63.0）	0.003	0.958

因素	完全再通组（72例）	不全再通组（54例）	χ²值	P值
年龄>45岁	12（16.7）	25（46.3）	13.060	0.000
男性	38（52.8）	35（64.8）	1.835	0.176
高血压	9（12.5）	17（31.5）	6.789	0.009
糖尿病	5（6.9）	6（11.1）	0.672	0.412
高脂血症	7（9.7）	11（20.4）	2.857	0.091
吸烟	18（25.0）	20（37.0）	2.123	0.145
继发性夹层	55（76.4）	36（66.7）	1.454	0.228
就诊距发病时间>30 d	9（12.5）	16（29.6）	5.693	0.017
夹层长段病变	50（69.4）	34（63.0）	0.583	0.445
管腔闭塞	7（9.7）	22（40.7）	16.756	0.000
抗血小板治疗	45（62.5）	34（63.0）	0.003	0.958

因素	β	SE	Wald χ²	P	OR	95%CI
年龄>45岁	1.279	0.470	7.398	0.007	3.594	1.430~9.033
高血压	1.111	0.528	4.430	0.035	3.037	1.079~8.544
就诊距发病时间>30 d	1.143	0.524	4.753	0.029	3.135	1.122~8.759
管腔闭塞	1.999	0.528	14.308	0.000	7.381	2.620~20.795

因素	β	SE	Wald χ²	P	OR	95%CI
年龄>45岁	1.279	0.470	7.398	0.007	3.594	1.430~9.033
高血压	1.111	0.528	4.430	0.035	3.037	1.079~8.544
就诊距发病时间>30 d	1.143	0.524	4.753	0.029	3.135	1.122~8.759
管腔闭塞	1.999	0.528	14.308	0.000	7.381	2.620~20.795

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