Temporalidad y factores de riesgo asociados al desarrollo de un infarto cerebral en pacientes con disección de arterias cervicales / Temporality and factors associated with the development of a cerebral infarction in patients with cervical artery dissection

INTRODUCCIÓN: Las disecciones de arterias cervicales (DAC) son la primera causa de accidente cerebrovascular isquémico (ACVi) en personas jóvenes. Los factores asociados (FA) de ACVi y la relación temporal con la DAC no están bien caracterizados. Tampoco disponemos de una clasificación clínico-radio-lógica que permita conocer el riesgo de ACVi. OBJETIVO: Describir frecuencia y FA y temporalidad de los ACVi en pacientes con DAC. MÉTODOS: Estudio prospectivo de pacientes mayores de 18 años hospitalizados por una DAC carotidea y/o vertebral entre agosto de 2009 y junio de 2017. Las DAC se diagnosticaron clínico-radiológicamente y los ACVi con imagen con infarto. Se utilizo la Clasificación de Borgess para caracterizar radiológicamente las DAC. Se utilizaron análisis de regresión logística uni y multivariable para evaluar las características clínico-radiológicas y los FA. RESULTADOS: 163 pacientes con 182 DAC (60% vertebrales y 40% carotídeas). 73 pacientes (44,8%) tuvieron un ACVi 28 de 68 pacientes (41,2%) tuvieron simultáneamente síntomas de disección y de isquemia. 60 de 68 pacientes (88%) presentan síntomas de isquemia durante la primera semana. FR significativamente asociados a ACVi: Borgess tipo IB (p = 0,001; OR: 4,1; IC: 1,8-9,3), sexo masculino (p < 0,001; OR: 0,2; IC: 0,06-0,8) y anticonceptivos orales (p = 0,02; OR: 0,2; IC: 0,06-0,8). CONCLUSIÓN: Ocurre aproximadamente en la mitad de los pacientes, en su mayoría dentro de la primera semana, no es la forma habitual de presentación inicial y no se relaciona con el tipo de arteria disecada. El principal FA para desarrollar un ACVi fue la oclusión arterial (Borgess tipo IB).

INTRODUCTION: Cervical artery dissections (CAD) are the leading cause of ischemic stroke (CVA) in young people. The risk factors for stroke and the temporal relationship with CAD are not well characterized. Nor do we have a clinical-radiological classification that allows knowing the risk of stroke. OBJECTIVE: To describe the associated factors and temporality of ACVi in patients with CAD. METHODS: We performed a prospective study that included patients over 18 years of age, hospitalized for carotid and/or vertebral CAD between August 2009 and June 2017. CAD cases were diagnosed clinically and radiologically; ACVi was diagnosed when the imaging study demonstrated infarction. The Borgess Classification was used to characterize the CAD radiologically. For correlation studies, we used univariate and multivariate logistic regression analyses. RESULTS: We analyzed 163 patients with 182 CAD (60% vertebral and 40% carotid). 28 of 68 patients (41.2%) simultaneously had symptoms of dissection and ischemia. 60 of 68 patients (88%) presented symptoms of ischemia during the first week. CAD: Borgess type IB (p = 0.001; OR: 4.1; CI: 1.8-9.3), male (p < 0.001; OR: 0.2; CI: 0.06- 0.8) were significantly associated with ischemic strokes and oral contraceptives (p = 0.02; OR: 0.2; CI: 0.06-0.8). CONCLUSION: Stroke associated with CAD has a relatively low frequency. It is not related to the type of dissected artery. It mainly occurs not simultaneously with CAD and within the first week. The main associated factor for developing a stroke is arterial occlusion (Borgess type IB).1,8-9,3), male sex (p < 0.001; OR: 0.2; CI: 0.06-0.8) and oral contraceptives (p = 0.02; OR: 0.2; CI: 0.06-0.8).

[Temporality and factors associated with the development of a cerebral infarction in patients with cervical artery dissection]. / Temporalidad y factores de riesgo asociados al desarrollo de un infarto cerebral en pacientes con disección de arterias cervicales.

INTRODUCTION: Cervical artery dissections (CAD) are the leading cause of ischemic stroke (CVA) in young people. The risk factors for stroke and the temporal relationship with CAD are not well characterized. Nor do we have a clinical-radiological classification that allows knowing the risk of stroke. OBJECTIVE: To describe the associated factors and temporality of ACVi in patients with CAD. METHODS: We performed a prospective study that included patients over 18 years of age, hospitalized for carotid and/or vertebral CAD between August 2009 and June 2017. CAD cases were diagnosed clinically and radiologically; ACVi was diagnosed when the imaging study demonstrated infarction. The Borgess Classification was used to characterize the CAD radiologically. For correlation studies, we used univariate and multivariate logistic regression analyses. RESULTS: We analyzed 163 patients with 182 CAD (60% vertebral and 40% carotid). 28 of 68 patients (41.2%) simultaneously had symptoms of dissection and ischemia. 60 of 68 patients (88%) presented symptoms of ischemia during the first week. CAD: Borgess type IB (p = 0.001; OR: 4.1; CI: 1.8-9.3), male (p < 0.001; OR: 0.2; CI: 0.06- 0.8) were significantly associated with ischemic strokes and oral contraceptives (p = 0.02; OR: 0.2; CI: 0.06-0.8). CONCLUSION: Stroke associated with CAD has a relatively low frequency. It is not related to the type of dissected artery. It mainly occurs not simultaneously with CAD and within the first week. The main associated factor for developing a stroke is arterial occlusion (Borgess type IB).1,8-9,3), male sex (p < 0.001; OR: 0.2; CI: 0.06-0.8) and oral contraceptives (p = 0.02; OR: 0.2; CI: 0.06-0.8).

Pseudoaneurisma de la arteria carótida interna extracraneana: reporte de tres casos y revisión de la literatura / Extracranial internal carotid artery pseudoaneurysm: case reports and a review of the literature

La disección de arteria carótida da cuenta de aproximadamente un 20 por ciento de los accidentes cerebrovasculares (ACV) isquémicos de pacientes jóvenes. En este grupo se detectan angiográficamente entre un 5 y 40 por ciento de formación de pseudoaneurismas. Objetivos. Presentar tres casos de disección espontánea de la arteria carótida interna extracraneana con formación de pseudoaneurisma y analizar la literatura en relación a la evolución natural de la enfermedad y las alternativas terapéuticas descritas, para definir la conducta terapéutica más adecuada. Métodos. Se revisan 3 casos de pseudoaneurisma carotídeo observados durante 2002 en el servicio de neurología de nuestra institución. Utilizando las palabras claves: pseudoaneurisma, diseccion de arteria carótida interna extracraneana, se hizo una búsqueda en Medline, revistas especializadas de neurología y neurocirugía entre los años 1980 y 2004. Resultados. Los tres casos presentados tuvieron un comportamiento benigno en el tiempo. No hubo evidencia de ruptura o embolización de los pseudoaneurismas durante los 22 meses de seguimiento. Los dos primeros casos presentaron una reducción significativa del tamaño del pseudoaneurisma, un 70 y 90 por ciento, respectivamente. El tercer caso presentó un pseudoaneurisma contralateral a disección carotídea sintomática, que se mantuvo sin cambios en los controles angiográficos. Todos los casos fueron manejados con anticoagulación inicial y luego con aspirinas. Conclusiones. Nuestros casos clínicos tuvieron un comportamiento benigno, al igual que lo reportado en la literatura. Dado el buen pronóstico de esta patología, un manejo conservador parece lo más razonable.

Carotid artery dissections are responsible for aproximately 20 percent of ischemic stroke in young adults. Pseudoaneurysms are detected angiographically in 5 percent-40 percent of carotid artery dissections. Objetives. To present three cases of carotid artery dissection with pseudoaneurysm formation and analyze literature in terms of the natural evolution and therapeutic alternatives of the disease in order to determine the best options for treatment. Methods. Tree carotid artery pseudoaneurysm cases presented during 2002 in our Department of Neurosurgery were reviewed. Research was done using Medline and specialized Neurology and Neurosurgery articles published between 1980 and 2003, using the key words pseudoaneurysm and extracranial carotid artery dissection. Results. The clinical course of the three cases presented was benign. There was no evidence of rupture or embolization of the pseudoaneuriysm during the 22 month mean follow-up period. The size of the pseudoaneurysm was reduced significantly in the first and second cases, 70 percent and 90 percent, respectively. The third case had a contralateral pseudoneurysm to the symptomatic carotid artery dissection, which remained unchanged in the angiographic controls. All cases were treated early with anticoagulants followed by antiplatelet therapy. Conclusions. Our cases had a benign outcome, as did those reported in literature. With this good prognosis, conservative management seems to be most reasonable course of action.