The Usefulness of MDCT Angiography in the Diagnosis of Vertebrobasilar Artery Dissection

PURPOSE: To evaluate the usefulness of MDCT angiography in the diagnosis of vertebrobasilar artery dissection. MATERIALS AND METHODS: Between July 2003 and December 2005, 39 patients who underwent MDCT angiography and digital subtraction angiography with a history of suspicious vertebrobasilar artery dissection were selected. A blind interpretation of images was made by two observers, retrospectively. A diagnosis of dissection in MDCT angiography was made according to the following criteria: presence of an intimal flap, aneurysmal dilatation, abrupt or tapered luminal narrowing, alternatively dilated and narrowed lumen. The sensitivity and specificity of MDCT angiography in depicting vertebrobasilar artery dissection were determined. RESULTS: 43 vertebrobasilar artery dissections were diagnosed by MDCT angiography in 39 patients. The interobserver agreement was good (kappa =0.92). A diagnosis was made by the presence of an intimal flap (n=16, 36%), abrupt or tapered luminal narrowing (n=16, 36%), aneurysmal dilatation (n=13, 30%), alternatively dilated and narrow lumen (n=14, 32%). The sensitivities and specificities of MDCT angiography were 91%, 88% as determined by the first radiologist, and were 89%, 87% as determined by a second radiologist, respectively. CONCLUSION: MDCT angiography is a useful method for the diagnosis of vertebrobasilar artery dissection.

Treatment of Internal Carotid Artery Dissections with Endovascular Stent Placement: Report of Two Cases

Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of traumarelated extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpet-rosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed.