AUTHOR=Yan Yanhong , Lu Ziwei , Ding Yafang , Pu Jianhong , Hu Chunhong , Teng Zhongzhao , Hui Pinjing TITLE=Predictors of ischemic events in patients with unilateral extracranial vertebral artery dissection: A single-center exploratory study JOURNAL=Frontiers in Neurology VOLUME=Volume 13 - 2022 YEAR=2022 URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.939001 DOI=10.3389/fneur.2022.939001 ISSN=1664-2295 ABSTRACT=Objective: Extracranial vertebral artery dissection (EVAD) is one of the main causes of stroke in young and middle-age patients. However, the diagnosis is challenging. This study aimed to identify the characteristics of EVAD on color duplex ultrasonography (CDU) and high-resolution magnetic resonance imaging (hrMRI) hoping to improve the accuracy, and to determine the relative contribution of vessel findings and clinical factors to acute ischemic events. Methods: Patients with unilateral EVAD were recruited and divided into ischemia and non-ischemia groups. Clinical features of patients and the lesion location, a variety of signs which indicate dissection including the presence of an intimal flap, double lumen, intramural hematoma, dissecting aneurysm, intraluminal thrombus, irregular lumen, and other quantitative parameters of each dissected segment on CDU and hrMRI were reviewed, respectively. Multiple logistic regression was used to examine the association between clinical, imaging features and ischemic events in patients with unilateral EVAD. Results: During a six-year period, ninety-six patients with unilateral EVAD who met inclusion criteria were enrolled. Overall, 41 cases (42.7%) were confirmed as ischemic stroke (n=40) or transient ischemic attack (n=1) during the 48 hours after onset of symptoms. Men, infections during the last week, and smoking were more often in the ischemia group. Intraluminal thrombus and occlusion on CDU were more prevalent in patients with cerebral ischemia than patients without (36.6% vs. 5.5%; p<0.001, and 39.0% vs. 9.1%; p=0.001, respectively). On hrMRI, intraluminal thrombus and occlusion were also more frequent in the ischemia group, compared with the non-ischemia group (34.1 % vs. 5.5%; p<0.001, and 34.1% vs. 9.1%; p=0.003, respectively). In addition, lesion length on hrMRI was significantly longer for patients with ischemia (81.5 ± 41.7 vs. 64.7 ± 30.8 mm; p=0.025). In multivariable logistic regression analysis, male gender, infections during the last week, and the presence of intraluminal thrombus on CDU and hrMRI were independently associated with acute ischemic events. Conclusion: Male sex, infections during the last week, and the presence of intraluminal thrombus due to dissection associated with an increased risk of ischemic events in patients with unilateral EVAD.