Increased Internal Carotid Artery Tortuosity is a Risk Factor for Spontaneous Cervicocerebral Artery Dissection

Lijuan Zhang; Xiaoshuang Liu; Beibei Gong; Qi Li; Tianyou Luo; FaJin Lv; Yineng Zheng; Wanlin Zheng; Haoming Guo

doi:10.1016/j.ejvs.2020.11.046

Increased Internal Carotid Artery Tortuosity is a Risk Factor for Spontaneous Cervicocerebral Artery Dissection

Eur J Vasc Endovasc Surg. 2021 Apr;61(4):542-549. doi: 10.1016/j.ejvs.2020.11.046. Epub 2021 Jan 2.

Authors

Lijuan Zhang¹, Xiaoshuang Liu¹, Beibei Gong¹, Qi Li², Tianyou Luo³, FaJin Lv¹, Yineng Zheng¹, Wanlin Zheng¹, Haoming Guo¹

Affiliations

¹ The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
² The Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
³ The Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address: ltycqfs@126.com.

PMID: 33402322
DOI: 10.1016/j.ejvs.2020.11.046

Abstract

Objective: Spontaneous cervicocerebral artery dissection (sCCD) is an important cause of ischaemic stroke that often occurs in young and middle aged patients. The purpose of this study was to investigate the correlation between tortuosity of the carotid artery and sCCD.

Methods: Patients with confirmed sCCD who underwent computed tomography angiography (CTA) were reviewed retrospectively. Age and sex matched patients having CTA were used as controls. The tortuosity indices of the cervical arteries were measured from the CTA images. The carotid siphon and the extracranial internal carotid artery (ICA) were evaluated according to morphological classification. The carotid siphons were classified into five types. The extracranial ICA was categorised as simple tortuosity, coiling or kinking. Independent risk factors for sCCD were investigated using multivariable analysis.

Results: The study included sixty-six patients with sCCD and 66 controls. There were no differences in vascular risk factors between the two groups. The internal carotid tortuosity index (ICTI) (25.24 ± 12.37 vs. 15.90 ± 8.55, respectively; p < .001) and vertebral tortuosity index (VTI) (median 11.28; interquartile range [IQR] 6.88, 18.80 vs. median 8.38; IQR 6.02, 12.20, respectively; p = .008) were higher in the patients with sCCD than in the controls. Type III and Type IV carotid siphons were more common in the patients with sCCD (p = .001 and p < .001, respectively). The prevalence of any vessel tortuosity, coiling and kinking of the extracranial ICA was higher in the patients with sCCD (p < .001, p = .018 and p = .006, respectively). ICTI (odds ratio [OR] 2.964; p = .026), VTI (OR 5.141; p = .009), and Type III carotid siphons (OR 4.654; p = .003) were independently associated with the risk of sCCD.

Conclusion: Arterial tortuosity is associated with sCCD, and greater tortuosity of the cervical artery may indicate an increased risk of arterial dissection.

Keywords: Arterial tortuosity; Cervical artery; Computed tomography angiography; Dissection.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Arteries / abnormalities*
Arteries / diagnostic imaging
Carotid Artery, Internal / abnormalities*
Carotid Artery, Internal / diagnostic imaging
Carotid Artery, Internal, Dissection / diagnostic imaging
Carotid Artery, Internal, Dissection / etiology*
Cerebral Angiography
Computed Tomography Angiography
Female
Humans
Joint Instability / complications*
Joint Instability / diagnostic imaging
Male
Middle Aged
Retrospective Studies
Risk Assessment
Risk Factors
Skin Diseases, Genetic / complications*
Skin Diseases, Genetic / diagnostic imaging
Vascular Malformations / complications*
Vascular Malformations / diagnostic imaging

Supplementary concepts

Arterial Tortuosity Syndrome
Internal Carotid Artery, Spontaneous Dissection of