Intracranial arterial dissections in ischemic stroke assessed by 3D rotational angiography

Background: Dissections involving intracranial arteries are sometimes difficult to assess using conventional digital subtraction angiography (DSA). We evaluated the value of three-dimensional rotational angiography (3D-RA) for the assessment of intracranial arterial dissections (ICADs). Methods: The subjects were 39 patients (26 males, 13 females; average age 50 ± 15 years) who were diagnosed as having ICADs and who underwent both DSA and 3D-RA in our hospital between April 1999 and March 2005. We retrospectively compared 3D-RA images to conventional DSA images in a blinded manner with respect to double lumen sign, pearl and string sign, string sign, and aneurysmal dilatation. On the basis of the caliber size of the artery affected by dissections, we divided patients into two groups: smaller artery group (S group) and larger artery group (L group). Results: The detection rate of double lumen sign with 3D-RA (79%) was significantly higher than with conventional DSA (18%; P < 0.001). Reliable findings of arterial dissections (double lumen sign and/or pearl and string sign) were observed more often with 3D-RA (90%) than with conventional DSA (36%; P < 0.001). In S group, the double lumen sign was detected only with 3D-RA. Conclusions: 3D-RA allows increased conspicuity of ICADs findings with conventional DSA, especially in smaller-caliber intracranial arteries.