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??Abstract??Cerebral arterial dissection (CAD) has been recognized as one of the most common causes of ischemic stroke in young people??and it occurs when there is a tear in the intimal layer of the carotid or vertebral arteries with subsequent extravasation of blood into the subintimal layers.Clinical diagnosis is often difficult for the signs and symptoms vary and are similar to etiologies that are encountered far more frequently.But computed tomographic angiography??magnetic resonance angiography??and digital subtraction angiography may aid in diagnosis.Management options include antiplatelet therapy??anticoagulation??thrombolysis and endovascular procedures.With the progress of the diagnosis and treatment technologies in recent years??early recognition of dissection and timely medical intervention are clinically feasible??which can improve the cure rate and reduce morbidity and mortality of the stroke from CAD.     

Spontaneous Celiac Artery Dissection Case Report and Literature Review

Symptomatic spontaneous celiac artery dissection is a rare condition that is being detected more often with the use of advanced imaging techniques. There is no consensus as to whether surgical or endovascular treatment is more appropriate.We describe the case of a 41-year-old hypertensive woman who presented with the sudden onset of sharp, persistent, right-upper-quadrant abdominal and epigastric pain. Magnetic resonance angiography of the abdomen revealed celiac artery dissection, with a flap compressing the lumen approximately 17 mm from the artery''s origin at the aorta. Because of the patient''s persistent epigastric pain, endovascular celiac artery stent implantation was performed with the use of 2 overlapping balloon-expandable stents. Twelve months after the procedure, the patient remained asymptomatic, and the stents were patent. This case and others in the medical literature suggest that endovascular treatment can be feasible in symptomatic patients with isolated spontaneous celiac artery dissection.Key words: Aneurysm, dissecting/diagnosis/radiography/therapy; angiography/methods; anticoagulants/therapeutic use; celiac artery/injuries/pathology/radiography; rupture, spontaneous/diagnosis/therapy; stents; vascular surgical proceduresIsolated spontaneous celiac artery dissection is rare. Most reported cases have occurred in men, and the cause and natural history of the condition are not well understood. In regard to symptomatic spontaneous dissection, it is debated whether surgical or endovascular treatment is more appropriate. We describe our endovascular treatment of spontaneous celiac artery dissection in a symptomatic female patient, and we discuss our findings in the context of previously reported cases.     

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??Abstract??Cervicocranial arterial dissection (CAD) is a common cause of stroke??especially in young adults.Along with clinical symptoms and signs??neuroimaging method is crucial to the diagnosis of CAD.Digital subtraction angiography is gradually being supplanted by noninvasive approaches such as magnetic resonance imaging (MRI)??magnetic resonance angiography (MRA)??computed tomographic angiography (CTA).In this article??we review the imaging diagnosis of CAD.     

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??Abstract??Cerebral artery dissection (CAD) implies an intimal tear in the wall of cerebral artery leading to the intrusion of blood into layers of the arterial wall (intramural haematoma).CAD has been reported in association with genetic factors??infections??migraine??hypertension and trauma.Clinical manifestations of CAD include headache??Horner’s syndrome??ipsilateral cranial nerves palsy??transient ischemic attack or stroke.Imaging examinations are very important for diagnosis of CAD.Digital subtraction angiography is the golden standard of CAD.Treatment of CAD is essentially depends on pharmacological approaches??and anticoagulant and antiplatelet agents are commonly used.Anticoagulant treatment of six month may fail in a small proportion of patients??and carotid aneurysms??surgical treatment should be performed in refractory patients with high-grade or worsening stenosis.     

Management of isolated superior mesenteric artery dissection

AIM:To evaluate our experience of the clinical management of spontaneous isolated superior mesenteric artery dissection(ISMAD).METHODS:From January 2008 to July 2013,18 patients with ISMAD were retrospectively analyzed,including 7 patients who received conservative therapy,9patients who received reconstruction with bare stents,and 2 patients who underwent surgical treatment.The decision to intervene was based on anatomic suitability,patient comorbidities and symptoms.RESULTS:Intestinal ischemia-related symptoms completely resolved in 7 patients who received conservative therapy.Stent placement was successful in 9patients.Of the 9 patients who received endovascular stenting,abdominal pain was alleviated after the procedure and gradually disappeared within 3 d.Followup computed tomography and computed tomography angiography were available in all patients during the first month and the first year after the procedure,which revealed patent stent and patent involved superior mesenteric artery branches with complete obliteration of the dissection lesion.In the 2 patients who underwent surgical treatment,good clinical efficacy was also observed.CONCLUSION:ISMAD may be managed successfully in a variety of ways based on the clinical symptoms.ISMAD should be treated by conservative management as the first-line option,however,in those with bowel necrosis or imminent arterial rupture during conservative therapy,endovascular or surgical therapy is indicated.     

Incidence and Treatment of Arterial Access Dissections Occurring during Cardiac Catheterization

BACKGROUND: Arterial access dissections may complicate cardiac catheterization and can often be treated percutaneously. The goal of this study was to examine the incidence, consequences, and the treatment of arterial access dissections at a tertiary referral hospital with an active training program. METHODS: Patients experiencing arterial access dissection during coronary angiography or intervention at our institution between October 1, 2004, and January 31, 2007, were identified and their records were retrospectively reviewed. RESULTS: Thirteen of the 3,062 consecutive patients (0.42%) had arterial access dissection during the study period. The location of the dissection was in the common femoral artery (CFA) (n = 6), the external iliac artery (EIA) (n = 6), or in an aortobifemoral graft (n = 1). Three of the six patients with CFA dissection were diagnosed during coronary angiography, and because of significant comorbidities were treated with self-expanding stents. After a mean follow-up of 7 months, they experienced no stent fracture or other complication. Six patients had EIA dissections. In one such patient, the dissection was not flow limiting and was treated conservatively. The remaining five patients underwent successful implantation of self-expanding stents, and during a mean follow-up of 9.6 months, no patient had any symptoms or events related to lower extremity ischemia. Finally, one patient had an aortobifemoral graft dissection. Due to the patient's critical condition, secondary to sepsis, his family elected to withdraw care, and he subsequently expired. CONCLUSIONS: Arterial access dissections occur infrequently during cardiac catheterization. Routine femoral artery angiography may help identify vascular access complications, often allowing simultaneous endovascular treatment, with excellent short-term outcomes.     

Postkoitale Kopfschmerzen als Leitsymptom einer Dissektion der Arteria carotis interna

Cervical artery dissection is the second most prevalent cause of an ischemic stroke in patients younger than 45 years old. The following case report describes a patient who developed severe holocephalic headaches and Horner??s syndrome after sexual intercourse. The radiological investigation showed a dissection of the left internal carotid artery (ICA). In emergency cases it is important to distinguish between dangerous headaches and idiopathic headache syndromes which are generally harmless. Serious causes of headaches, which should be diagnosed safely are subarachnoid haemorrhage, thrombosis of a sinus or a cervical arterial dissection. The main symptoms of an ICA dissection are painful Horner??s syndrome, carotodyny or a pulsating neck pain. Evidence of an ICA dissection is a hematoma in the vascular wall seen on MRI in T1 or T2 weighted axial images. Current therapy includes treatment with unfractionated heparin. After the PTT reaches 2?C3 times its basal level, the recommended therapy is oral anticoagulation with phenprocoumone. The goal is to obtain an INR between 2.0 and 3.0 for 3?C24 months.     

Cervical carotid artery dissection: current review of diagnosis and treatment

Carotid artery dissection is a cause of stroke, especially in young and middle-aged patients. A dissection occurs when there is an intimal tear or rupture of the vasa vasorum, leading to an intramural hematoma, which is thought to result from trauma or can occur spontaneously, and is likely multifactorial, involving environmental and intrinsic factors. The clinical diagnosis of carotid artery dissection can be challenging, with common presentations including pain, partial Horner syndrome, cranial nerve palsies, or cerebral ischemia. With the use of noninvasive imaging, including magnetic resonance and computed tomography angiography, the diagnosis of carotid dissection has increased in frequency. Treatment options include thrombolysis, antiplatelet or anticoagulation therapy, endovascular or surgical interventions. The choice of appropriate therapy remains controversial as most carotid dissections heal on their own and there are no randomized trials to compare treatment options.     

合并主动脉夹层的冠心病患者联合冠状动脉介入治疗的临床分析

目的评价合并主动脉夹层的冠心病患者联合进行覆膜支架及冠状动脉介入治疗的安全性和有效性。方法选择合并主动脉夹层的冠心病患者共12例,已行外科治疗Ⅰ型主动脉夹层1例,大血管CT血管成像明确诊断Ⅲ型主动脉夹层和壁间血肿11例,冠状动脉造影并置入支架,住院观察,并行院外随访。结果 1例Ⅰ型主动脉夹层患者大血管CT血管成像可见覆膜支架、人工血管形态正常,冠状动脉造影显示,3支血管病变,共置入支架3枚;另11例Ⅲ型主动脉夹层和壁间血肿患者行大动脉覆膜支架治疗,大动脉造影显示,破口封闭,冠状动脉造影显示,16支血管病变,共置入支架18枚。其中1例术后仍有胸背部疼痛,大血管CT血管成像显示,主动脉弓降部可见残存破口,真腔明显受压,再次置入微创覆膜支架后症状缓解出院,住院及随访期间无胸痛再发、死亡、肾功能恶化、偏瘫等。结论对同时合并主动脉夹层的冠心病患者进行联合介入治疗安全性好,术后恢复快。     

Peripheral arterial involvement in Behcet’s disease: an analysis of the results from a Korean referral center

The purposes of this study are to review the results of endovascular and surgical interventions and to evaluate clinical appearances of recurrent arterial involvement in patients with peripheral arterial Behçet disease (BD). A total of 28 patients with peripheral arterial BD were identified. There were 24 males (85.7 %), with mean age of 40.0 ± 9.0 years (range 21–59). Arterial involvements were confirmed with computed tomography angiography, magnetic resonance image angiography, or ultrasound. Immunosuppressive agents were administrated to all patients. Indications of intervention were acute symptoms due to arterial occlusion and aneurysmal changes with or without rupture. Among 28 patients with peripheral arterial BD, 10 endovascular and 24 surgical interventions were performed in 21 patients. All 21 patients who underwent endovascular and surgical intervention were followed up for a mean duration of 78.7 ± 52.5 months (range 0–182 months). There was one mortality due to the rupture of pseudoaneurysm in patient who underwent stent-graft insertion for abdominal aortic aneurysm. New arterial involvements of BD occurred in 10 patients. All patients were male, and median age was 33.5 years (range 29–59 years). Mean time of onset of the new arterial lesion was 32.7 ± 32.1 months. In conclusion, the result of endovascular and surgical interventions is satisfactory in patients with acute peripheral arterial BD. Accurate diagnosis with immunosuppressive therapy is mandatory to prevent recurrence and activation of peripheral arterial BD.