Extracranial vertebral artery dissection: Findings and advantages of ultrasonography

Vertebral artery dissection (VAD) is not uncommon in the young adult population. Owing to the various clinical manifestations; the diagnosis of VAD mainly depends on imaging examinations. Ultrasound has found an increasingly wide utilization in the diagnosis of VAD because of the continuous improvement in the resolution of ultrasonic instruments and accessibility. We retrospectively collected the data of patients with a US-proven extracranial vertebral artery dissection. In accordance with the sonographic findings, all patients were classified as having intramural hematoma, double-lumen dissection, and occlusion dissection. The patients’ age, sex, risk factors for cerebrovascular diseases, and sonographic characteristics were analyzed. A total of 37 cases of US-proven extracranial vertebral artery dissections were included in this study. Thirty patients presented with intramural hematoma dissection, 1 had double-lumen dissection and 6 had occlusion dissection. No dissecting aneurysm was found in any of the patients. Concerning a subsequent angiographic examination, 13 patients failed to undergo the examination for various reasons. The remaining 24 patients underwent digital subtraction angiography (DSA), magnetic resonance angiography (MRA), and computerized tomographic angiography (CTA), among whom 1 patient with intramural hematoma was underdiagnosed because the DSA result was interpreted as normal. One patient who underwent CTA had a contrast allergy. In the remaining patients, the results of other imaging examinations were consistent with the US results. Intramural hematoma dissection is the most common type of extracranial vertebral artery dissection. Over other angiographic examinations US has a big diagnostic advantage for its direct view, accuracy, and low cost.