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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleExtracranial Vascular
Open Access

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

J.C. Benson, V.T. Lehman, J.T. Verdoorn, D.P. Shlapak, S.N. Hayes and M.S. Tweet
American Journal of Neuroradiology May 2021, DOI: https://doi.org/10.3174/ajnr.A7151
J.C. Benson
aFrom the Department of Radiology (J.C.B., V.T.L., J.T.V., D.P.S.), Mayo Clinic, Rochester, Minnesota
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V.T. Lehman
aFrom the Department of Radiology (J.C.B., V.T.L., J.T.V., D.P.S.), Mayo Clinic, Rochester, Minnesota
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J.T. Verdoorn
aFrom the Department of Radiology (J.C.B., V.T.L., J.T.V., D.P.S.), Mayo Clinic, Rochester, Minnesota
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D.P. Shlapak
aFrom the Department of Radiology (J.C.B., V.T.L., J.T.V., D.P.S.), Mayo Clinic, Rochester, Minnesota
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S.N. Hayes
bDepartment of Cardiovascular Medicine (S.N.H., M.S.T.), Mayo Clinic, Rochester, Minnesota
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M.S. Tweet
bDepartment of Cardiovascular Medicine (S.N.H., M.S.T.), Mayo Clinic, Rochester, Minnesota
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  • FIG 1.
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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).

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    Table 1:

    Prevalence of various imaging findings in patients with SCADa

    FindingsNo. (%)
    FMD83/214 (38.8%)
    Dissection and/or pseudoaneurysm28/214 (13.1%)
    Aneurysm/ectasia22/214 (10.3%)
    Carotid web10/214 (4.7%)
    1+ type of carotid tortuosity99/214 (46.3%)
    Atherosclerosis
        None185/214 (86.4%)
        Mild26/214 (12.2%)
        Moderate3/214 (1.4%)
        Severe0/214 (0.0%)
    Vertebral tortuosity
        None124/214 (57.9%)
        Mild64/214 (29.9%)
        Moderate22/214 (10.3%)
        Severe4/214 (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.

    • View popup
    Table 2:

    Prevalence of FMD, dissection and/or pseudoaneurysm, aneurysm/ectasia, and webs based on arterial involvementa

    Right Carotid ArteryLeft Carotid ArteryBoth Carotid ArteriesRight Vertebral ArteryLeft Vertebral ArteryBoth Vertebral Arteries
    FMD56 (25.2%)49 (22.9%)39 (18.2%)30 (14.0%)32 (15.0%)22 (10.3%)
    Dissection and/or pseudoaneurysm5 (2.3%)8 (3.7%)0 (0.0%)8 (3.7%)12 (5.6%)1 (0.5%)
    Aneurysm/ectasia16 (7.5%)13 (6.1%)8 (3.7%)4 (1.9%)3 (1.4%)1 (0.5%)
    Web6 (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. (%).

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J.C. Benson, V.T. Lehman, J.T. Verdoorn, D.P. Shlapak, S.N. Hayes, M.S. Tweet
Prevalence of Cervical Artery Abnormalities on CTA in Patients with Spontaneous Coronary Artery Dissection: Fibromuscular Dysplasia, Dissection, Aneurysm, and Tortuosity
American Journal of Neuroradiology May 2021, DOI: 10.3174/ajnr.A7151

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Prevalence of Cervical Artery Abnormalities on CTA in Patients with Spontaneous Coronary Artery Dissection: Fibromuscular Dysplasia, Dissection, Aneurysm, and Tortuosity
J.C. Benson, V.T. Lehman, J.T. Verdoorn, D.P. Shlapak, S.N. Hayes, M.S. Tweet
American Journal of Neuroradiology May 2021, DOI: 10.3174/ajnr.A7151
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