CTA Head With IV Contrast CTA of the head may be useful in the evaluation for intracranial extension of a known cervical dissection. CTA of the head may also be useful for evaluation of intracranial collaterals of the circle of Willis and excluding associated intracranial LVO, which is important in stroke risk stratification and treatment strategies. As such, although a CTA of the head may be necessary in the workup of a known cervical artery dissection, there is no literature to support CTA of the head in the initial screening examination for a suspected cervical artery dissection. CTA Neck With IV Contrast CTA of the neck is useful in the initial screening examination for suspected cervical vascular dissection owing to rapid acquisition and high spatial resolution of the examination. Rapid examination is important in the evaluation for suspected cervical dissection due to the stroke risk associated with treatment delays. The high resolution of CTA neck allows for the detection of fairly subtle dissections with high sensitivity for both cervical carotid and vertebral artery dissections with a sensitivity and specificity approaching 98% [129]. CTA neck can rapidly and accurately grade the degree of luminal narrowing, vessel irregularity, wall thickening/hematoma, pseudoaneurysm, and intimal flap, which may make it preferable to MRA [130]. CTA neck also allows for fairly accurate grading of dissections comparable to digital subtraction angiography, which may be helpful in clinical management [131]. The potential detractors from CTA of the neck are the requirements for iodinated contrast and ionizing radiation. CTV Head With IV Contrast There is no relevant literature to support the use of CTV of the head in the initial imaging of suspected cervical vascular dissection or injury.
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. CTA Head With IV Contrast CTA of the head may be useful in the evaluation for intracranial extension of a known cervical dissection. CTA of the head may also be useful for evaluation of intracranial collaterals of the circle of Willis and excluding associated intracranial LVO, which is important in stroke risk stratification and treatment strategies. As such, although a CTA of the head may be necessary in the workup of a known cervical artery dissection, there is no literature to support CTA of the head in the initial screening examination for a suspected cervical artery dissection. CTA Neck With IV Contrast CTA of the neck is useful in the initial screening examination for suspected cervical vascular dissection owing to rapid acquisition and high spatial resolution of the examination. Rapid examination is important in the evaluation for suspected cervical dissection due to the stroke risk associated with treatment delays. The high resolution of CTA neck allows for the detection of fairly subtle dissections with high sensitivity for both cervical carotid and vertebral artery dissections with a sensitivity and specificity approaching 98% [129]. CTA neck can rapidly and accurately grade the degree of luminal narrowing, vessel irregularity, wall thickening/hematoma, pseudoaneurysm, and intimal flap, which may make it preferable to MRA [130]. CTA neck also allows for fairly accurate grading of dissections comparable to digital subtraction angiography, which may be helpful in clinical management [131]. The potential detractors from CTA of the neck are the requirements for iodinated contrast and ionizing radiation. CTV Head With IV Contrast There is no relevant literature to support the use of CTV of the head in the initial imaging of suspected cervical vascular dissection or injury.