Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography

Chifumi Kitanaka Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima; and Department of Neurosurgery, Tokyo University School of Medicine, Tokyo, Japan

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Jun-Ichi Tanaki Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima; and Department of Neurosurgery, Tokyo University School of Medicine, Tokyo, Japan

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Masanori Kuwahara Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima; and Department of Neurosurgery, Tokyo University School of Medicine, Tokyo, Japan

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Akira Teraoka Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima; and Department of Neurosurgery, Tokyo University School of Medicine, Tokyo, Japan

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Tomio Sasaki Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima; and Department of Neurosurgery, Tokyo University School of Medicine, Tokyo, Japan

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Kintomo Takakura Department of Neurosurgery, Teraoka Memorial Hospital, Hiroshima; and Department of Neurosurgery, Tokyo University School of Medicine, Tokyo, Japan

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✓ The question of whether unruptured intracranial vertebral artery dissections should be treated surgically or nonsurgically still remains unresolved. In this study, six consecutive patients with intracranial vertebral artery dissection presenting with brain-stem ischemia without subarachnoid hemorrhage (SAH) were treated nonsurgically with control of blood pressure and bed rest, and five received follow-up review with serial angiography. No further progression of dissection or associated SAH occurred in any of the cases, and all patients returned to their previous lifestyles. In the serial angiograms in five patients, the findings continued to change during the first few months after onset. Four cases ultimately showed “angiographic cure,” while fusiform aneurysmal dilatation of the affected vessel persisted in one case. In one patient, arterial dissection was visualized on the second angiogram despite negative initial angiographic findings.

These results indicate that intracranial vertebral artery dissection presenting without SAH can be treated nonsurgically, with careful angiographic follow-up monitoring. Persistent aneurysmal dilatation as a sequela of arterial dissection seemed to form a subgroup of fusiform aneurysms of the posterior circulation. These aneurysms may be prone to late bleeding and may require surgical treatment.

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