Introduction: Vertebral artery dissection (VAD) is a critical cause of ischemic stroke in young and middle-aged adults. Emboli Detection Studies (EDS) using transcranial Doppler ultrasonography have been proposed as a potential tool to assess stroke risk in VAD patients. However, its predictive value remains uncertain, especially for the posterior circulation. This study aims to evaluate the effectiveness of EDS in predicting stroke in patients with VAD and to identify the associated risk factors.
Methods: We retrospectively reviewed 104 consecutive patients with VAD who underwent EDS at our institution. Doppler ultrasonography was used to detect microemboli, and patients were followed for stroke outcomes. Data were analyzed to determine correlations between microemboli detection and stroke occurrence.
Results: A total of 104 patients with spontaneous (58%), traumatic (39%) or iatrogenic (4%) VAD were included in our analysis. Stroke occurred more frequently in patients with spontaneous VAD compared to traumatic VAD (p < 0.001). Microemboli were detected in 17 patients (16%), including 18.3% of spontaneous VAD, 12.5% of traumatic VAD, and 25% of iatrogenic VAD. 61 patients (59%) suffered a posterior circulation stroke, however there was no significant association between detection of microemboli and stroke events (60% of patients without microemboli vs. 53% of patients with ≥1 HITS during EDS; p = 0.6). Similarly, no microemboli were detected in any of the patients who went on to develop a delayed stroke.
Conclusion : In our single-institution retrospective analysis of patients with VAD, the detection of microemboli on EDS was not associated with stroke nor was it predictive of delayed stroke. Additionally, patients with spontaneous VAD may be at higher risk for stroke compared to traumatic VAD.
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