What is the role of neuroimaging in the workup of vertebral artery dissection (VAD)?

Updated: Feb 21, 2019
  • Author: Eddy S Lang, MDCM, CCFP(EM), CSPQ; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Diagnosis of vertebral artery dissection (VAD) is usually made by neuroimaging, which has largely replaced conventional angiography in most centers. [32] The 2011 combined ASA/ACCF/AHA guidelines gave a class I recommendation to noninvasive computed tomography angiography (CTA) or magnetic resonance angiography (MRA) as the initial diagnostic study for suspected VAD. [33] These studies were favored over ultrasonography, but there was no specific guidance on CTA over MRA provided. If these imaging modalities are inconclusive for VAD but the clinical suspicion remains high, the guidelines gave a class IIa recommendation to either serial noninvasive imaging or invasive contrast angiography (if the patients would be candidates for revascularization). [33]

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