Long-term follow-up study of unruptured vertebral artery dissection: clinical outcomes and serial angiographic findings

View More View Less
  • 1 Department of Neurosurgery, Osaka Neurological Institute, Osaka, Japan
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object. Although the spontaneous occurrence of an unruptured vertebral artery (VA) dissection has increasingly been recognized as a relatively common cause of stroke, and the clinical aspects of this lesion have gradually been determined, its natural course remains obscure. The main goal of this study was to clarify the management protocol for this condition by examining serial angiographic changes in patients with unruptured VA dissections.

Methods. Seventeen patients with unruptured VA dissections, including 13 men and four women, were clinically and angiographically examined between 1993 and 1998. All patients were observed using serial angiography studies. The initial angiography examinations most frequently revealed stenotic lesions (appearance of a pearl-andstring sign or string sign) in eight (47.1%) of 17 cases. In 15 cases (88.2%), changes in the lesions were evident on follow-up angiography studies. Stenotic lesions resulted in occlusion in four cases, normalization in three, and subsequent formation of an aneurysm in one case, which was treated successfully by proximal occlusion of the affected vessel performed using a detachable balloon. Occluded lesions, which were initially observed in three patients, recanalized in two patients and remained unchanged in one patient. Fusiform dilation alone was demonstrated in three patients during the initial angiography session; these lesions became normalized or were unchanged on follow-up studies. Saccular aneurysms were observed in two patients. In one of these cases, proximal ligation of the parent artery was successfully performed because of subsequent aneurysm enlargement. A double lumen, which appeared in one patient with an extradural VA dissection, became occluded. Magnetic resonance T2-weighted imaging studies revealed infarction corresponding to the posterior circulation in seven cases. During long-term observation in this series, good or excellent recovery was obtained in 14 (87.5%) of 16 patients, and moderate or severe disability in two (12.5%); one patient was lost to follow up after the second angiography study.

Conclusions. A follow-up angiography study must be performed during the early stage (within approximately 3 weeks after onset of symptoms) to confirm the formation or enlargement of an aneurysm, because such conditions may be amenable to surgical treatment. Unruptured VA dissection could otherwise be treated and followed conservatively. Although the majority of dissected lesions seem likely to stabilize within a few months, as evidenced on angiography, in some cases a longer observation period is required.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Kazuhiko Nakagawa, M.D., Department of Neurosurgery, Tokyo Metropolitan Toshima Hospital, 33–1, Sakae-chou, Itabashi-ku, Tokyo 173–0015, Japan.
  • 1.

    Akiyama Y, , Itoh T, & Kumai J, et al: [Vertebral artery dissection without subarachnoid hemorrhage studied by serial angiography.] No Shinkei Geka 24:443449, 1996 (Jpn) Akiyama Y, Itoh T, Kumai J, et al: [Vertebral artery dissection without subarachnoid hemorrhage studied by serial angiography.] No Shinkei Geka 24:443–449, 1996 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 2.

    Caplan LR, , Baquis GD, & Pessin MS, et al: Dissection of the intracranial vertebral artery. Neurology 38:868877, 1988 Caplan LR, Baquis GD, Pessin MS, et al: Dissection of the intracranial vertebral artery. Neurology 38:868–877, 1988

    • Search Google Scholar
    • Export Citation
  • 3.

    De Bray JM, , Penisson-Besnier I, & Dubas F, et al: Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis. J Neurol Neurosurg Psychiatry 63:4651, 1997 De Bray JM, Penisson-Besnier I, Dubas F, et al: Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis. J Neurol Neurosurg Psychiatry 63:46–51, 1997

    • Search Google Scholar
    • Export Citation
  • 4.

    Endoh H, , Kayama T, & Endoh H, et al: [A case of vertebrobasilar dissection which was associated with progressing stroke and successfully treated by intravascular surgery in the acute stage.] No Shinkei Geka 26:10011005, 1998 (Jpn) Endoh H, Kayama T, Endoh H, et al: [A case of vertebrobasilar dissection which was associated with progressing stroke and successfully treated by intravascular surgery in the acute stage.] No Shinkei Geka 26:1001–1005, 1998 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 5.

    Hosoya T, , Adachi M, & Yamaguchi K, et al: Clinical and neuroradiological features of intracranial vertebrobasilar artery dissection. Stroke 30:10831090, 1999 Hosoya T, Adachi M, Yamaguchi K, et al: Clinical and neuroradiological features of intracranial vertebrobasilar artery dissection. Stroke 30:1083–1090, 1999

    • Search Google Scholar
    • Export Citation
  • 6.

    Kasner SE, , Hankins LL, & Bratina P, et al: Magnetic resonance angiography demonstrates vascular healing of carotid and vertebral artery dissections. Stroke 28:19931997, 1997 Kasner SE, Hankins LL, Bratina P, et al: Magnetic resonance angiography demonstrates vascular healing of carotid and vertebral artery dissections. Stroke 28:1993–1997, 1997

    • Search Google Scholar
    • Export Citation
  • 7.

    Kitanaka C, , Sasaki T, & Eguchi T, et al: Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations. Neurosurgery 34:620627, 1994 Kitanaka C, Sasaki T, Eguchi T, et al: Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations. Neurosurgery 34:620–627, 1994

    • Search Google Scholar
    • Export Citation
  • 8.

    Kitanaka C, , Tanaka J, & Kuwahara M, et al: Magnetic resonance imaging study of intracranial vertebrobasilar artery dissections. Stroke 25:571575, 1994 Kitanaka C, Tanaka J, Kuwahara M, et al: Magnetic resonance imaging study of intracranial vertebrobasilar artery dissections. Stroke 25:571–575, 1994

    • Search Google Scholar
    • Export Citation
  • 9.

    Kitanaka C, , Tanaka JI, & Kuwahara M, et al: Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography. J Neurosurg 80:667674, 1994 Kitanaka C, Tanaka JI, Kuwahara M, et al: Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography. J Neurosurg 80:667–674, 1994

    • Search Google Scholar
    • Export Citation
  • 10.

    Leclerc X, , Lucas C, & Godefroy O, et al: Preliminary experience using contrast-enhanced MR angiography to assess vertebral artery structure for the follow-up of suspected dissection. AJNR 20:14821490, 1999 Leclerc X, Lucas C, Godefroy O, et al: Preliminary experience using contrast-enhanced MR angiography to assess vertebral artery structure for the follow-up of suspected dissection. AJNR 20:1482–1490, 1999

    • Search Google Scholar
    • Export Citation
  • 11.

    Levy C, , Laissy JP, & Raveau V, et al: Carotid and vertebral artery dissections: three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography. Radiology 190:97103, 1994 Levy C, Laissy JP, Raveau V, et al: Carotid and vertebral artery dissections: three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography. Radiology 190:97–103, 1994

    • Search Google Scholar
    • Export Citation
  • 12.

    McCormick GF, & Halbach VV: Recurrent ischemic events in two patients with painless vertebral artery dissection. Stroke 24:598602, 1993 McCormick GF, Halbach VV: Recurrent ischemic events in two patients with painless vertebral artery dissection. Stroke 24:598–602, 1993

    • Search Google Scholar
    • Export Citation
  • 13.

    Mizutani T, , Aruga T, & Kirino T, et al: Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905913, 1995 Mizutani T, Aruga T, Kirino T, et al: Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905–913, 1995

    • Search Google Scholar
    • Export Citation
  • 14.

    Mokri B, , Houser W, & Sandok BA, et al: Spontaneous dissections of the vertebral arteries. Neurology 38:880885, 1988 Mokri B, Houser W, Sandok BA, et al: Spontaneous dissections of the vertebral arteries. Neurology 38:880–885, 1988

    • Search Google Scholar
    • Export Citation
  • 15.

    Nomura M, , Kida S, & Yamashita J, et al: Endovascular embolization of unruptured vertebral dissection using guglielmi electrolytically detachable coils: case report. J Int Med Res 27:101105, 1999 Nomura M, Kida S, Yamashita J, et al: Endovascular embolization of unruptured vertebral dissection using guglielmi electrolytically detachable coils: case report. J Int Med Res 27:101–105, 1999

    • Search Google Scholar
    • Export Citation
  • 16.

    Onda H, , Tanikawa T, & Takeshita M, et al: [Management for dissecting aneurysms of the vertebral artery.] No Socchu No Geka 22:293299, 1994 (Jpn) Onda H, Tanikawa T, Takeshita M, et al: [Management for dissecting aneurysms of the vertebral artery.] No Socchu No Geka 22:293–299, 1994 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 17.

    Ono J, & Yamaura A: [An analysis of intracranial dissecting aneurysms of the vertebrobasilar system: treatment and the longterm outcome of 50 cases.] No Socchu No Geka 3:128134, 1994 (Jpn) Ono J, Yamaura A: [An analysis of intracranial dissecting aneurysms of the vertebrobasilar system: treatment and the longterm outcome of 50 cases.] No Socchu No Geka 3:128–134, 1994 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 18.

    Ono J, , Yamaura A, & Kobayashi S, et al: [Management of unruptured intracranial dissecting aneurysms in vertebrobasilar system: analysis of serial changes in angiographic findings and long-term outcome.] No Socchu No Geka 23:167172, 1995 (Jpn) Ono J, Yamaura A, Kobayashi S, et al: [Management of unruptured intracranial dissecting aneurysms in vertebrobasilar system: analysis of serial changes in angiographic findings and long-term outcome.] No Socchu No Geka 23:167–172, 1995 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 19.

    Pozzati E, , Andreoli A, & Limoni P, et al: Dissecting aneurysms of the vertebrobasilar system: study of 16 cases. Surg Neurol 41:119124, 1994 Pozzati E, Andreoli A, Limoni P, et al: Dissecting aneurysms of the vertebrobasilar system: study of 16 cases. Surg Neurol 41:119–124, 1994

    • Search Google Scholar
    • Export Citation
  • 20.

    Pozzati E, , Padovani R, & Fabrizi A, et al: Benign arterial dissections of the posterior circulation. J Neurosurg 75:6972, 1991 Pozzati E, Padovani R, Fabrizi A, et al: Benign arterial dissections of the posterior circulation. J Neurosurg 75:69–72, 1991

    • Search Google Scholar
    • Export Citation
  • 21.

    Provenzale JM, , Morgenlander JC, & Gress D: Spontaneous vertebral dissection: clinical, conventional angiographic, CT, and MR findings. J Comput Assist Tomogr 20:185193, 1996 Provenzale JM, Morgenlander JC, Gress D: Spontaneous vertebral dissection: clinical, conventional angiographic, CT, and MR findings. J Comput Assist Tomogr 20:185–193, 1996

    • Search Google Scholar
    • Export Citation
  • 22.

    Quint DJ, & Spickler EM: Magnetic resonance demonstration of vertebral artery dissection. Report of two cases. J Neurosurg 72:964967, 1990 Quint DJ, Spickler EM: Magnetic resonance demonstration of vertebral artery dissection. Report of two cases. J Neurosurg 72:964–967, 1990

    • Search Google Scholar
    • Export Citation
  • 23.

    Yamaura A, , Watanabe Y, & Saeki N: Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183188, 1990 Yamaura A, Watanabe Y, Saeki N: Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183–188, 1990

    • Search Google Scholar
    • Export Citation
  • 24.

    Yokoyama M, , Kurita I, & Yamashita M, et al: [Dissecting aneurysm of the vertebro-basilar artery. Case report.] Neurol Med Chir 24:343348, 1984 (Jpn) Yokoyama M, Kurita I, Yamashita M, et al: [Dissecting aneurysm of the vertebro-basilar artery. Case report.] Neurol Med Chir 24:343–348, 1984 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 25.

    Yonas H, , Agamanolis D, & Takaoka Y, et al: Dissecting intracranial aneurysms. Surg Neurol 8:407415, 1977 Yonas H, Agamanolis D, Takaoka Y, et al: Dissecting intracranial aneurysms. Surg Neurol 8:407–415, 1977

    • Search Google Scholar
    • Export Citation
  • 26.

    Yoshimoto Y, & Wakai S: Unruptured intracranial vertebral artery dissection: clinical course and serial radiographic imagings. Stroke 28:370374, 1997 Yoshimoto Y, Wakai S: Unruptured intracranial vertebral artery dissection: clinical course and serial radiographic imagings. Stroke 28:370–374, 1997

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 708 279 29
Full Text Views 269 28 0
PDF Downloads 169 20 0
EPUB Downloads 0 0 0