Prevalence of Cervical Artery Abnormalities on CTA in Patients with Spontaneous Coronary Artery Dissection: Fibromuscular Dysplasia, Dissection, Aneurysm, and Tortuosity

American Journal of Neuroradiology

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FIG 1.
Examples of cervical artery abnormalities noted in patients with SCAD. Axial CTA (A) demonstrates a right vertebral artery dissection (curved arrow). Reformatted sagittal (B) and coronal (C) images show multifocal FMD of the right ICA. Axial CTA (D) demonstrates a web in the right ICA bulb (straight arrow). Reformatted axial CTA (E) shows ectasia of the distal right vertebral artery (asterisks).
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FIG 2.
Examples of tortuosity subtypes. Arterial kink (A) (a single arterial angulation of ≤90°), loop (B) (2 adjacent acute angulations of the vessel), and coil (C) (complete 360° turn) are all shown. Also note the beaded irregularity of the vessel in C, compatible with FMD (arrows).

Table 1:

Prevalence of various imaging findings in patients with SCAD^{^a}

Findings	No. (%)
FMD	83/214 (38.8%)
Dissection and/or pseudoaneurysm	28/214 (13.1%)
Aneurysm/ectasia	22/214 (10.3%)
Carotid web	10/214 (4.7%)
1+ type of carotid tortuosity	99/214 (46.3%)
Atherosclerosis
None	185/214 (86.4%)
Mild	26/214 (12.2%)
Moderate	3/214 (1.4%)
Severe	0/214 (0.0%)
Vertebral tortuosity
None	124/214 (57.9%)
Mild	64/214 (29.9%)
Moderate	22/214 (10.3%)
Severe	4/214 (1.9%)

↵a FMD, dissection, pseudoaneurysm, and aneurysm/ectasia numbers reflect the number of patients with those findings in either the carotid or vertebral artery. Webs were only assessed in the carotid arteries because they are considered to be rarely present in the vertebral arteries. Subtypes of carotid tortuosity include kinks, loops, coils, and retropharyngeal and retrojugular courses. Carotid atherosclerosis and vertebral tortuosity reflect the more severe side, if asymmetry existed.

Table 2:

Prevalence of FMD, dissection and/or pseudoaneurysm, aneurysm/ectasia, and webs based on arterial involvement^{^a}

	Right Carotid Artery	Left Carotid Artery	Both Carotid Arteries	Right Vertebral Artery	Left Vertebral Artery	Both Vertebral Arteries
FMD	56 (25.2%)	49 (22.9%)	39 (18.2%)	30 (14.0%)	32 (15.0%)	22 (10.3%)
Dissection and/or pseudoaneurysm	5 (2.3%)	8 (3.7%)	0 (0.0%)	8 (3.7%)	12 (5.6%)	1 (0.5%)
Aneurysm/ectasia	16 (7.5%)	13 (6.1%)	8 (3.7%)	4 (1.9%)	3 (1.4%)	1 (0.5%)
Web	6 (2.8%)	6 (2.8%)	0 (0.0%)	NA

Note:—NA indicates not applicable.
↵a The presence or absence of webs within the vertebral arteries was not assessed because they are classically found in the carotid bulbs. Data are No. (%).