Dissecting Aneurysms of Intracranial Carotid Circulation

Abstract

Background and Purpose-Clinical features of nontraumatic dissecting aneurysms of intracranial carotid circulation remain unclear because investigation of this disease has been limited to case reports. The aim of this study was to investigate the clinical features of this disease through the use of cooperatively collected cases. Methods-The cases diagnosed as dissecting aneurysms of intracranial carotid circulation on the basis of clinical signs and neuroradiological findings in 46 stroke centers from 1995 through 1999 were collected, and their clinical features were analyzed. Results-Forty-nine cases of dissecting aneurysms of intracranial carotid circulation were collected. Thirty-two patients presented with subarachnoid hemorrhage (SAH), and 17 presented with cerebral ischemia. The ratio of this disease to all intracranial dissecting aneurysms treated in the same institutes for the same period was 19.1%, and the ratio of SAH resulting from this disease to SAH of unverified origin treated in the same institutes for the same period was 6.2%. The predominant site of lesion was the internal carotid artery in 18 of 32 patients (56%) with SAH and the anterior cerebral artery in 13 of 17 patients (76%) with cerebral ischemia. The predominant angiographic findings were that stenosis with dilatation occurred in 20 of 32 patients (63%) with SAH and stenosis without dilatation was seen in 11 of 17 patients (65%) with cerebral ischemia. Poor prognosis was seen in 21 of 32 patients (66%) with SAH, which was due largely to rebleeding seen preoperatively, during operation, and even postoperatively when clipping or wrapping of the aneurysmal bulge was performed. Conclusions-Nontraumatic

Stent placement for the treatment of complex internal carotid bifurcation aneurysms: a review of 16 cases

“…Fusiform aneurysms in anterior circulation are mainly located ICA (18,24). These aneurysm used to be treated via a "destructive" approach, such as trapping, parent artery occlusion, or surgical resection followed by function bypass.…”

“…These aneurysm used to be treated via a "destructive" approach, such as trapping, parent artery occlusion, or surgical resection followed by function bypass. However, the complications are thought to be high in most reports (18,24). In recent years, reconstructive approach is preferred to treat these aneurysms, and reported to be safe and effective (24).…”

Dilated Outer Diameter of the Dissected Artery: Acute Bilateral Anterior Cerebral Artery Dissection Evaluated by Repeat Magnetic Resonance Cisternography -Case Report-

“…Detection of double lumen or intimal flap at the affected artery are definitive but uncommon findings of arterial dissection. 2,[7][8][9] Pearl and string sign or string sign on angiography are accepted as suggestive findings for dissection. [7][8][9] Intramural hematoma on T 1 -weighted MR imaging is helpful to identify dissection in the early phase, 2,3,[7][8][9] but does not always appear in the acute phase.…”

“…[7][8][9] Intramural hematoma on T 1 -weighted MR imaging is helpful to identify dissection in the early phase, 2,3,[7][8][9] but does not always appear in the acute phase. 2,3) Morphological changes of the dissected artery on serial angiography are reliable indicators of dissection, 2,8) but acute dissection cannot be established based only on the initial angiography. More suggestive findings for dissection in the acute phase would be very helpful to manage patients with suspected dissection.…”

Spontaneous Intracranial Internal Carotid Artery Dissection Treated by Intra-arterial Thrombolysis and Superficial Temporal Artery-Middle Cerebral Artery Anastomosis in the Acute Stage-Case Report-

“…Dissection of the intracranial carotid artery has been recognized as a cause of ischemic stroke, especially in young adults, since 1990. 2,[19][20][21][22]25) The incidence and natural history of intracranial internal carotid artery (ICA) dissection remain unclear because few cases have been described. The prognosis for these patients is considered to be good in general, although massive cerebral infarct was reported in severe cases.…”