Clinical characteristics and management of vertebral artery dissection without definitive imaging features: A single center cohort study

Background Management of vertebral artery dissection (VAD), which is difficult to diagnose definitively on imaging, is a clinical concern. The aim of this study was to clarify the clinical characteristics of VAD without definitive imaging features and evaluate our clinical decisions and their consequences. Methods We searched our database to identify patients with VAD registered between January 2008 and December 2021. We performed a retrospective chart review to obtain detailed clinical information and compared the clinical characteristics and radiological findings between patients with definitive VAD and those with non-definitive VAD by radiological findings at the initial evaluation. Results Of 188 patients (mean age 52.7 ± 12.3 years, 121 male), 127 had definitive VAD. Patients in the definitive group had a younger average age and a high rate of intramural hematoma, while those in the non-definitive group were more likely to have a history of hypertension. Overall, the prognosis was good for the majority (n = 163), and there was no significant difference in the prognosis between two groups. Especially, the prognosis of non-definitive VAD patients without stroke was favorable. Conclusions Cases of non-definitive VAD are likely to be complicated by atherosclerotic changes. Therefore, clinicians should carefully evaluate the potential etiologies based on the clinical history and imaging data to provide patients with the optimal treatment options. Identification of IMH was an important factor to make a definitive diagnosis, and the vessel wall imaging is a useful imaging modality for the purpose.