Ischemic stroke with and without brachiocephalic artery dissections: results of comprehensive examination of patients

Abstract

Currently, there are no clearly defined optimal diagnostic strategies of detection of dissections. This study aimed to analyze and compare the results of comprehensive examinations of people who suffered an ischemic stroke (IS) with and without brachiocephalic artery (BCA) dissections. Dissections group, formed based on the results of multispiral computed tomography angiography that confirmed dissections, included 53 patients, and control group — patients without BCA dissections — comprised 1451 people; examination of all patients involved duplex scanning (DS) of BCA and transcranial part, transthoracic echocadiography (TTE), multispiral computed tomography angiography (msCTA) and/or magnetic resonance imaging (MRI). Patients with dissection were younger (p < 0.0005) and had a lower body mass index (p < 0.0005) than participants from the control group; according to echocadiography, they were less likely to have left (p = 0.014) and right (p = 0.018) atrial dilation and aortic stenosis (p = 0.017). Also, dissections were significantly less often associated with atherosclerotic plaques in the common carotid artery (CCA) (p < 0.002), and BCA deformations (p < 0.05). Duplex scanning of BCA revealed that in patients with dissections, differentiation of the intima-media complex in CCA was compromised significantly less often, and signs of thrombosis of the internal carotid artery were registered significantly more often (p = 0.021 and p = 0.004); according to MRI, such patients had less pronounced changes in the periventricular and deep white matter of the brain (p < 0.0005 and p = 0.001) and never suffered strategic infarcts affecting the thalamus area (p < 0.0005). Comparison of the results of examinations of IS patients with and without BCA dissections revealed differences that are probably conditioned by the younger age of those who had said dissections.