Management of Intracranial Vertebral Artery Dissections Initially Presenting without Subarachnoid Hemorrhage

Naito, Isao; Iwai, Tomohiro; Sasaki, Tomio

doi:10.1097/00006123-200210000-00013

Cited by 79 publications

(59 citation statements)

References 20 publications

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“…Previous studies have shown that patients with unruptured siVAD present with SAH during medical follow-up [14,15] and have suggested siVAD, even when unruptured, to be dynamic lesions carrying a significant risk of hemorrhage [1]. …”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous intradural vertebral artery dissection (siVAD) initially presenting without subarachnoid hemorrhage (SAH) has been more frequently identified since the introduction of magnetic resonance (MR) imaging as a diagnostic modality [1]. Although SAH from unruptured siVAD is thought to be rare [2,3,4,5], autopsy investigations have shown ruptured siVAD in 41% [6] and the frequency of SAH from unruptured siVAD has also been suggested to be higher than previously considered [1].…”

Section: Introductionmentioning

confidence: 99%

“…Although SAH from unruptured siVAD is thought to be rare [2,3,4,5], autopsy investigations have shown ruptured siVAD in 41% [6] and the frequency of SAH from unruptured siVAD has also been suggested to be higher than previously considered [1]. …”

Section: Introductionmentioning

confidence: 99%

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Differences in Vertebrobasilar Artery Morphology between Spontaneous Intradural Vertebral Artery Dissections with and without Subarachnoid Hemorrhage

Matsukawa¹,

Shinoda²,

Fujii³

et al. 2012

Cerebrovasc Dis

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Background: Patients with spontaneous intradural vertebral artery dissection (siVAD) developing subarachnoid hemorrhage (SAH) have been observed to have poor outcomes. Factors predisposing siVAD patients to SAH are not well known. We aimed to investigate the clinical and vertebrobasilar artery morphological characteristics associated with SAH in patients with siVAD. Methods: We reviewed 103 consecutive patients with siVAD managed at our facility between July 2003 and June 2012. We divided the patients into groups, with (n = 22) and without (n = 81) SAH, and compared clinical and vertebrobasilar artery morphological characteristics between them. The vertebral-union-basilar angle (VUBA) was defined as the most acute angle between the line of the basilar artery trunk and the line of the vertebral artery at the vertebral union on 3-dimensional magnetic resonance angiography, computed tomographic angiography, or digital subtraction angiography. ‘Steep vertebral artery’ was defined as VUBA >45°. Basilar artery bending was defined as the longest distance from the line which connected the basilar top and vertebral artery union to the greatest bending point of the basilar artery. Results: Stepwise logistic regression analysis was performed using variables that were marginally or significantly associated with SAH on univariate analysis (p < 0.10) and that were thought to be clinically important for SAH. It showed SAH patients to have significantly higher proportions of current smoking (OR: 7.7; 95% CI: 2.7–22; p = 0.0015), dissection of the dominant vertebral artery (OR: 4.9; 95% CI: 1.8–13; p = 0.043), steep vertebral artery of the dissecting side (OR: 7.2; 95% CI: 2.6–20; p = 0.0023), posterior inferior cerebellar artery involvement (OR: 4.0; 95% CI: 1.3–13; p = 0.011), basilar artery bending <3 mm (OR: 3.4; 95% CI: 1.3–9.5; p = 0.0040), and pearl-and-string sign (OR: 5.7; 95% CI: 2.0–16; p = 0.0033). Conclusions: We suggest that the clinical and vertebrobasilar artery morphological characteristics demonstrated in the present study may be related to SAH induced by siVAD. Although all patients with siVAD should be closely monitored, those with siVAD who have these characteristics should perhaps be more closely followed than those who do not have such features.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Differences in Vertebrobasilar Artery Morphology between Spontaneous Intradural Vertebral Artery Dissections with and without Subarachnoid Hemorrhage

Matsukawa¹,

Shinoda²,

Fujii³

et al. 2012

Cerebrovasc Dis

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“…[14,[17][18][19]20] In our patients, in this study, 87.5% of VA aneurysms were dissecting and 12.5% were saccular type. The most common finding in our series was a pseudoaneurysm with irregular vessel lumen narrowing proximally.…”

Section: Discussionmentioning

confidence: 77%

“…Only aneurysms involving VA above C2 and without involving the basilar trunk were included. Patients were divided into ruptured (17) and unruptured (21), and patients with unruptured VA aneurysm presented with cerebral ischemia, mass effect or discovered incidentally after imaging for unrelated pathology. Diagnosis of subarachnoid hemorrhage (SAH) was based on computed tomography (CT) findings.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Characteristics and endovascular treatment of intracranial vertebral artery aneurysms

et al. 2011

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What Caused This Subarachnoid Haemorrhage?

Warlow¹,

Gijn²,

Dennis³

et al. 2008

Stroke

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Management of Intracranial Vertebral Artery Dissections Initially Presenting without Subarachnoid Hemorrhage

Abstract: The risk of bleeding from unruptured VA dissections is higher than previously considered. Therefore, endovascular treatment should be considered for patients with VA dissections with relatively large or growing aneurysmal dilations.

Cited by 79 publications

References 20 publications

Differences in Vertebrobasilar Artery Morphology between Spontaneous Intradural Vertebral Artery Dissections with and without Subarachnoid Hemorrhage

Differences in Vertebrobasilar Artery Morphology between Spontaneous Intradural Vertebral Artery Dissections with and without Subarachnoid Hemorrhage

Characteristics and endovascular treatment of intracranial vertebral artery aneurysms

What Caused This Subarachnoid Haemorrhage?

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