Cerebrovascular dissections associated with major nonpenetrating trauma are typically graded on the Biffl scale, which is in most cases colloquially referred to as the Denver grading scale. Higher-grade dissections are more likely to result in ischemic complications [126]. For these dissections associated with major nonpenetrating trauma, repeat imaging with CTA neck is recommend at 7 days and again at 3 months [133]. For patients with minor or no trauma, outcome is not correlated with the degree of subsequent recanalization Cerebrovascular Diseases-Stroke so a role of follow-up imaging has not been established [134-136]. The subsequent surveillance imaging of cervical vascular dissections centers on the evaluation of healing of the dissection, risk stratification, and development for ongoing ischemic and hemorrhagic complications. Surveillance imaging is less focused on screening for intracranial complication of known dissection beyond the early stages of vascular injury. For indicated imaging in patients with focal neurological deficits relative to cervicocerebral dissections, please see Variants 1 to 5 for additional indicated imaging procedures. Dissection may also be the result of suspected connective tissue disorder, which may also warrant further imaging workup. Arteriography Cervicocerebral Catheter-directed cerebral angiography may be useful in the surveillance imaging of some selected cases of known vascular dissection. Specifically, assessment for complete healing of a previously symptomatic dissection or assessment of progression of a known dissection with new or ongoing focal neurological symptom may be more completely assessed by catheter-directed angiography owing to higher spatial and temporal resolution compared with other vascular studies.
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. Cerebrovascular dissections associated with major nonpenetrating trauma are typically graded on the Biffl scale, which is in most cases colloquially referred to as the Denver grading scale. Higher-grade dissections are more likely to result in ischemic complications [126]. For these dissections associated with major nonpenetrating trauma, repeat imaging with CTA neck is recommend at 7 days and again at 3 months [133]. For patients with minor or no trauma, outcome is not correlated with the degree of subsequent recanalization Cerebrovascular Diseases-Stroke so a role of follow-up imaging has not been established [134-136]. The subsequent surveillance imaging of cervical vascular dissections centers on the evaluation of healing of the dissection, risk stratification, and development for ongoing ischemic and hemorrhagic complications. Surveillance imaging is less focused on screening for intracranial complication of known dissection beyond the early stages of vascular injury. For indicated imaging in patients with focal neurological deficits relative to cervicocerebral dissections, please see Variants 1 to 5 for additional indicated imaging procedures. Dissection may also be the result of suspected connective tissue disorder, which may also warrant further imaging workup. Arteriography Cervicocerebral Catheter-directed cerebral angiography may be useful in the surveillance imaging of some selected cases of known vascular dissection. Specifically, assessment for complete healing of a previously symptomatic dissection or assessment of progression of a known dissection with new or ongoing focal neurological symptom may be more completely assessed by catheter-directed angiography owing to higher spatial and temporal resolution compared with other vascular studies.