{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T18:29:28Z","timestamp":1767896968815,"version":"3.49.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,5,7]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Vertebral artery dissections (VADs) may extend from the extracranial to the intracranial vasculature (e+iVAD). We evaluated how the characteristics of e+iVAD differed from those of intracranial VAD (iVAD).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              From 2002 to 2019, among consecutive patients with cervicocephalic dissection, those with iVAD and e+iVAD were included, and their clinical characteristics were compared. In patients with unruptured dissections, a composite clinical outcome of subsequent ischemic events, subsequent hemorrhagic stroke, or mortality was evaluated. High\u2010resolution magnetic resonance images were analyzed to evaluate intracranial remodeling index. Among 347 patients, 51 (14.7%) had e+iVAD and 296 (85.3%) had iVAD. The hemorrhagic presentation occurred solely in iVAD (0.0% versus 19.3%), whereas e+iVAD exhibited higher ischemic presentation (84.3% versus 27.4%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). e+iVAD predominantly presented steno\u2010occlusive morphology (88.2% versus 27.7%) compared with dilatation patterns (11.8% versus 72.3%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) of iVAD. The ischemic presentation was significantly associated with e+iVAD (iVAD as a reference; adjusted odds ratio, 3.97 [95% CI, 1.67\u20139.45];\n              <jats:italic>P<\/jats:italic>\n              =0.002]). Patients with unruptured VAD showed no differences in the rate of composite clinical outcome between the groups (log\u2010rank,\n              <jats:italic>P<\/jats:italic>\n              =0.996). e+iVAD had a lower intracranial remodeling index (1.4\u00b10.3 versus 1.6\u00b10.4;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.032) and a shorter distance from dural entry to the maximal dissecting segment (6.9\u00b18.4 versus 15.7\u00b17.4;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">e+iVAD is associated with lower rates of hemorrhages and higher rates of ischemia than iVAD at the time of admission. This may be explained by a lower intracranial remodeling index and less deep intrusion of the dissecting segment into the intracranial space.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.031032","type":"journal-article","created":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T10:22:28Z","timestamp":1714731748000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Behavior of Extracranial\u2010to\u2010Intracranial Extended Arterial Dissections of the Vertebral Artery"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8625-6968","authenticated-orcid":false,"given":"So Young","family":"Park","sequence":"first","affiliation":[{"name":"Department of Neurology Ajou University School of Medicine, Ajou University Medical Center Suwon South 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