Management and Clinical Outcome of Acute Basilar Artery Dissection

Kim, B. M.; Suh, Sang Hyun; Park, S. I.; Shin, Yong Sam; Chung, Eun Chul; Lee, M. H.; Kim, E. J.; Koh, Jun Seok; Kang, Hyun-Seung; Roh, Hong Gee; Won, Yu Sam; Chung, Pil-Wook; Kim, Y. B.; Suh, Beomseok

doi:10.3174/ajnr.a1243

Cited by 75 publications

(97 citation statements)

References 16 publications

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“…It is well known that stent placement decreases wall shear stress in the aneurysm wall in proportion to the number of overlapping stents. 21,22 As in many previous case studies, 4,5,9,[23][24][25][26] this study showed promising results for the use of multiple overlapping stents, with or without coiling, in the treatment of VBDAs. Newly developed flow diverters, which have far less porosity than conventional neurovascular or coronary stents, may play a decisive role in reconstructive treatment of VBDAs.…”

Section: Discussionsupporting

confidence: 70%

“…Поскольку проведение оперативного вмешательства сопряжено с высоким риском пос-ледующей заболеваемости и летального исхода [7], в лечении РАВБАС предпочтение отдается эндовас-кулярным методам лечения. До сих пор были пред-ставлены небольшие исследования эндоваскулярных методов лечения РАВБАС [3][4][5][8][9][10]. Во многих слу-чаях зарегистрировали развитие рецидива РАВБАС с или без САК после эндоваскулярного лечения [5,9,[10][11][12][13][14][15][16][17].…”

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“…Артериальная гипертензия, n (%): 0,482 да (n=14) 1 (7,1) 13 (92,9) нет (n=86) 12 (20,0) 74 (80,0) Курение, n (%): 0,148 0,712 (0,707,0,472) да (n=33) 2 (6,1) 31 (93,9) нет (n=67) 11 (16,4) 56 (83,6) Двустороннее поражение, n (%): 0,040 0,458 (1,744,0,588) да (n=18) 5 (27,8) 13 (72,2) нет (n=82) 8 (9,8) ющих наблюдений проиллюстрировали последнее объяснение (рис. 3).…”

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“…Хорошо известно, что установка стента приводит к снижению гемодинамического удара на стенку аневризмы пропорционально числу установленных перекрывающихся стентов [21,22]. Как и во многих ранее проведенных исследованиях серий случаев [4,5,9,[23][24][25][26], настоящее исследование продемонс-трировало многообещающие результаты исполь-зования нескольких перекрывающихся стентов в сочетании с койлингом или без него в лечении РАВБАС. Недавно разработанные диверторы крово-тока с меньшей пористостью, чем у традиционных нейрососудистых или коронарных стентов, могут сыграть решающую роль в реконструктивном лече-нии РАВБАС [27,28].…”

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Incidence and Risk Factors of Recurrence After Endovascular Treatment of Intracranial Vertebrobasilar Dissecting Aneurysms

Kim

Shin

Kim

et al. 2011

Stroke

113

143

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Background and Purpose-The incidence and risk factors for recurrence after endovascular treatment of intracranial vertebrobasilar dissecting aneurysms (VBDAs) have not been studied. We aimed to evaluate the incidence and risk factors for recurrence after endovascular treatment of VBDAs. Methods-A total of 111 patients (mean age, 45Ϯ10 years) underwent endovascular treatment for 119 VBDAs (ruptured/unrupturedϭ73:46). Incidence and risk factors for recurrence were retrospectively evaluated. Results-Sixty-two VBDAs were treated by a reconstructive technique by using 1 to 3 overlapping stents with or without coiling, and 57 VBDAs were treated by a deconstructive technique by using proximal occlusion or internal trapping at the dissected segment of the parent artery. Follow-up angiography was available for 97 VBDAs (81.5%) in 89 patients at 3 days to 48 months (median, 13 months) after treatment. There were 13 recurrences: 6 had rebleeding but 7 had no rebleeding. All 6 hemorrhagic recurrences had initially presented with a ruptured form. Ten recurrences were confirmed by angiography, but 3 recurrences with rebleeding did not receive follow-up angiography. The rate of post-treatment recurrence did not differ between reconstructive and deconstructive treatments. Involvement of the posterior inferior cerebellar artery origin (odds ratioϭ8.026; 95% confidence interval, 1.561 to 41.259; Pϭ0.013) was the only independent risk factor for recurrence. Conclusions-There was a 13% recurrence after endovascular treatment of VBDAs. Posterior inferior cerebellar artery origin involvement was the only independent risk factor for recurrence after endovascular treatment of VBDAs. (Stroke. 2011;42:2425-2430.)

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Section: Discussionsupporting

confidence: 70%

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Incidence and Risk Factors of Recurrence After Endovascular Treatment of Intracranial Vertebrobasilar Dissecting Aneurysms

Kim

Shin

Kim

et al. 2011

Stroke

113

143

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“…wall and arterial reconstruction by direct surgical ligation or clipping) and endovascular treatment (such as embolization of parent vessels to reduce or reverse blood flow) (1,21,22 (6,10,12,13,19).…”

Section: A B C Dmentioning

confidence: 99%

Endovascular coil embolization of parent artery for giant intracranial basilar artery dissection: a case report

Xu²,

Wang³

et al. 2010

Turkish Neurosurgery

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Isolated dissection of the basilar artery (BA) is rare and still a big challenge regarding treatment. The suitable therapeutic strategies for dissection of the BA remain controversial. We report the case of a young patient with a giant unruptured dissection of the BA successfully treated by endovascular coil embolization. A 14-year-old male who underwent computed tomography (CT) scan following a minor head trauma was incidentally found to have a lesion located anterior to brain stem. Further imaging with magnetic resonance imaging (MRI), computed tomography angiography (CTA) and digital subtraction angiography (DSA) were consistent with a diagnosis of giant unruptured dissection of the BA. The patient was initially observed conservatively. The follow-up DSA obtained 3 months later revealed extension of the dissection inferiorly to involve the left VA. The dissection expanded at the conjunction of VAs in the shape of ball. Therefore, coil embolization to occlude BA at the bottom of aneurysm was performed as a further treatment. Follow-up DSA 6 months later demonstrated complete obliteration of the dissection and good compensative perfusion from extensively collateral circulation. For young patients with isolated dissection of the BA, coil embolization to occlude BA at the bottom of aneurysm might be tolerable and effective.KeywoRds: Basilar artery, Giant, Dissection, Endovascular embolization, Treatment ÖZBaziler arterin (BA) izole diseksiyonu nadirdir ve tedavisi halen zordur. BA diseksiyonu için uygun terapötik stratejiler tartışmalıdır. Dev bir rüptüre olmamış BA diseksiyonu bulunan ve endovasküler sarmal embolizasyonuyla başarıyla tedavi edilen genç bir hasta sunuyoruz. Küçük bir kafa travması sonrasında bilgisayarlı tomografi (BT) yapılan 14 yaşında bir erkek hastada beyin kökünün önünde bir lezyon saptandı. Manyetik rezonans görüntüleme (MRG), bilgisayarlı tomografi anjiyografi (BTA) ve dijital subtraksiyon anjiyografisi (DSA) ile yapılan ileri görüntüleme sonuçları rüptüre olmamış dev BA diseksiyonu tanısıyla uyumluydu. Hasta başlangıçta konservatif olarak izlendi. Üç ay sonra çekilen takip DSA, diseksiyonun inferiora uzanıp sol VA'yı da olaya kattığını gösterdi. Diseksiyon VA'ların birleşiminde bir top şeklinde genişlemişti. Bu nedenle ileri tedavi olarak anevrizma dibinde BA oklüzyonu için sarmal embolizasyonu yapıldı. Altı ay sonra yapılan kontrol DSA diseksiyonda tam obliterasyon ve yaygın kollateral dolaşımdan iyi kompanse edici perfüzyon gösterdi. İzole BA diseksiyonu olan hastalarda anevrizma dibinde BA oklüzyonu için sarmal embolizasyonu tolere edilebilir ve etkin olabilir. ANAHTAR sÖZCÜKLeR:Baziler arter, Dev, Diseksiyon, Endovasküler embolizasyon, Tedavi

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