Repair of a vertebral artery dissection

1986 ◽  
Vol 64 (4) ◽  
pp. 662-665 ◽  
Author(s):  
J. Jeffrey Alexander ◽  
Seymour Glagov ◽  
Christopher K. Zarins
Keyword(s):  
Vertebral Artery ◽  
Surgical Therapy ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Aggressive Approach ◽  
Content Type ◽  
Satisfactory Recovery ◽  
Fine Print

✓ The case is presented of a 38-year-old woman who suffered multiple cerebellar infarctions as a result of emboli from a vertebral artery dissection. Surgical therapy led to a satisfactory recovery. This case emphasizes the importance of an aggressive approach to such lesions.

Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients

2004 ◽  
Vol 101 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Masaru Yamada ◽  
Takao Kitahara ◽  
Akira Kurata ◽  
Kiyotaka Fujii ◽  
Yoshio Miyasaka
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Conservative Treatment ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Delayed Diagnosis ◽  
Acute Stage ◽  
Artery Dissection ◽  
Content Type ◽  
String Structure ◽  
Fine Print

Object. Intracranial vertebral artery (VA) dissection with subarachnoid hemorrhage is notorious for frequent rebleeding and a poor prognosis. Nevertheless, some patients survive with a good final outcome. The factors associated with the prognosis of this disease are not fully understood and appropriate treatment strategies continue to be debated. The authors retrospectively evaluated the clinical features of conservatively treated patients to elucidate the relationship between the clinical and angiographic characteristics of the disease and final outcomes. Methods. This study includes 24 patients who were treated by conservative methods between 1990 and 2000. Conservative treatment was chosen because of delayed diagnosis, poor clinical condition, or anatomical features such as bilateral lesions and contralateral VA hypoplasia. Of nine patients with an admission Hunt and Kosnik Grade I or II, eight had good outcomes (mean follow-up period 8 years and 4 months). All 15 patients with Grade III, IV, or V died and in 10 of these the cause of death was rebleeding. Among the 24 patients, 14 suffered a total of 35 rebleeding episodes; in 10 (71.4%) of these 14 patients rebleeding occurred within 6 hours and in 13 (93%) within 24 hours. Compared with the survivors, there was a female preponderance (0.022) among patients who died. These patients also had significantly shorter intervals between onset and hospital admission (p = 0.0067), a higher admission Hunt and Kosnik grade (p = 0.0001), a higher incidence of prehospitalization (p = 0.0296) and postadmission (p = 0.0029) rebleeding episodes, and a higher incidence of angiographically confirmed pearl-and-string structure of the lesion (p = 0.0049). Conclusions. In our series of preselected patients, poor admission neurological grade, rebleeding episode(s), and lesions with a pearl-and-string structure were predictive of poor outcomes. Our findings indicate that patients with these characteristics may be candidates for aggressive attempts to prevent rebleeding during the acute stage. Patients without these characteristics may be good candidates for conservative treatment, especially those who survive the acute phase without rebleeding.

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

1994 ◽  
Vol 80 (4) ◽  
pp. 667-674 ◽  
Author(s):  
Chifumi Kitanaka ◽  
Jun-Ichi Tanaki ◽  
Masanori Kuwahara ◽  
Akira Teraoka ◽  
Tomio Sasaki ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Bed Rest ◽  
Arterial Dissection ◽  
Artery Dissection ◽  
Aneurysmal Dilatation ◽  
Content Type ◽  
Brain Stem Ischemia ◽  
Fine Print

✓ 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.

Endovascular treatment of vertebral artery dissections and pseudoaneurysms

1993 ◽  
Vol 79 (2) ◽  
pp. 183-191 ◽  
Author(s):  
Van V. Halbach ◽  
Randall T. Higashida ◽  
Christopher F. Dowd ◽  
Kenneth W. Fraser ◽  
Tony P. Smith ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Transluminal Angioplasty ◽  
Artery Dissection ◽  
Parent Artery ◽  
Content Type ◽  
Balloon Test Occlusion ◽  
Endovascular Occlusion ◽  
Proximal Occlusion ◽  
Fine Print

✓ Sixteen patients with dissecting aneurysms or pseudoaneurysms of the vertebral artery, 12 involving the intradural vertebral artery and four occurring in the extradural segment, were treated by endovascular occlusion of the dissection site. Patients with vertebral fistulas were excluded from this study. The dissection was caused by trauma in three patients (two iatrogenic) and in the remaining 13 no obvious etiology was disclosed. Nine patients presented with subarachnoid hemorrhage (SAH), two of whom had severe cardiac disturbances secondary to the bleed. The nontraumatic dissections occurred in seven women and six men, with a mean age on discovery of 48 years. Fifteen patients were treated with endovascular occlusion of the parent artery at or just proximal to the dissection site. One patient had occlusion of a traumatic pseudoaneurysm with preservation of the parent artery. Four patients required transluminal angioplasty because of severe vasospasm produced by the presenting hemorrhage, and all benefited from this procedure with improved arterial flow documented by transcranial Doppler ultrasonography and arteriography. In 15 patients angiography disclosed complete cure of the dissection. One patient with a long dissection of extracranial origin extending intracranially had proximal occlusion of the dissection site. Follow-up angiography demonstrated healing of the vertebral artery dissection but persistent filling of the artery above the balloons, which underscores the need for embolic occlusion near the dissection site. No hemorrhages recurred. One patient had a second SAH at the time of therapy which was immediately controlled with balloons and coils. This patient and one other had minor neurological worsening resulting from the procedure (mild Wallenberg syndrome in one and minor ataxia in the second). Symptomatic vertebral artery dissections involving the intradural and extradural segments can be effectively managed by endovascular techniques. Balloon test occlusion and transluminal angioplasty can be useful adjuncts in the management of this disease.

Rebleeding from vertebral artery dissection after proximal clipping

1992 ◽  
Vol 77 (3) ◽  
pp. 466-468 ◽  
Author(s):  
Chifumi Kitanaka ◽  
Tadashi Morimoto ◽  
Tomio Sasaki ◽  
Kintomo Takakura
Keyword(s):  
Surgical Technique ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Content Type ◽  
Fine Print

✓ The authors present the case of a patient with vertebral artery dissection that rebled after being treated by proximal clipping. This is the second report of such a case. The results indicated that proximal clipping is not free from the risk of rebleeding, and a better alternative surgical technique should always be sought when treating vertebral artery dissections.

Angiographic frequency of saccular intracranial aneurysms in patients with spontaneous cervical artery dissection

1992 ◽  
Vol 76 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Wouter I. Schievink ◽  
Bahram Mokri ◽  
David G. Piepgras
Keyword(s):  
General Population ◽  
Intracranial Aneurysms ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Angiographic Study ◽  
Content Type ◽  
Cervical Artery ◽  
Male Patients ◽  
Fine Print

✓ The pathogenesis of intracranial aneurysms and spontaneous cervical artery dissection is incompletely understood but a primary arteriopathy, possibly similar in both disorders, may be of importance. To investigate the frequency of intracranial aneurysms in patients with spontaneous cervical artery dissection, the angiograms of 164 patients who were diagnosed at the Mayo Clinic as having spontaneous extracranial carotid or vertebral artery dissection were reviewed. Thirteen intracranial aneurysms were detected in nine (5.5%) of the 164 patients: eight (8.8%) of the 91 female patients and one (1.4%) of the 73 male patients. The frequency of intracranial aneurysms in these patients was significantly higher (p < 0.01) than that observed in a recent angiographic study from the same institution, estimating the frequency of intracranial aneurysms in the general population (1.1%). The significance of these findings is discussed.

Posttraumatic lumbar epidural true synovial cyst

1973 ◽  
Vol 39 (2) ◽  
pp. 246-248 ◽  
Author(s):  
George W. Sypert ◽  
Richard W. Leech ◽  
A. Basil Harris
Keyword(s):  
Surgical Therapy ◽  
Cauda Equina ◽  
Synovial Cyst ◽  
Content Type ◽  
Cauda Equina Compression ◽  
Satisfactory Recovery ◽  
Fine Print

✓ A case is reported of posttraumatic epidural true synovial cyst causing cauda equina compression. Surgical therapy resulted in satisfactory recovery.

Spontaneous retroclival hematoma presenting as a thunderclap headache

2001 ◽  
Vol 95 (3) ◽  
pp. 522-524 ◽  
Author(s):  
Wouter I. Schievink ◽  
Reid C. Thompson ◽  
Christopher T. Loh ◽  
M. Marcel Maya
Keyword(s):  
Sinus Thrombosis ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Vertebral Artery Dissection ◽  
Thunderclap Headache ◽  
Ct Scans ◽  
Uneventful Recovery ◽  
Artery Dissection ◽  
Rare Type ◽  
Content Type ◽  
Fine Print

✓ An excruciating headache of instantaneous onset, or thunderclap headache, may be caused by a variety of serious disorders, including aneurysmal subarachnoid hemorrhage, cerebral venous sinus thrombosis, pituitary apoplexy, and carotid artery or vertebral artery dissection. The authors describe a patient with this type of headache who was found to have a spontaneous retroclival hematoma. A 49-year-old woman experienced an instantaneous excruciating headache. Results of computerized tomography (CT) scans of the head were normal, but on examination of the cerebrospinal fluid xanthochromia was found. Magnetic resonance (MR) imaging of the cervical spine revealed a retroclival hematoma. Three cerebral angiographic studies did not reveal the source of the hemorrhage and a repeated MR image demonstrated resolution of the hematoma. The patient made an uneventful recovery. Spontaneous retroclival hematoma is an exceedingly rare type of intracranial hemorrhage and may be associated with normal findings on CT scans. Spontaneous retroclival hematoma should be included in the differential diagnosis of thunderclap headache.

Magnetic resonance demonstration of vertebral artery dissection

1990 ◽  
Vol 72 (6) ◽  
pp. 964-967 ◽  
Author(s):  
Douglas J. Quint ◽  
Eric M. Spickler
Keyword(s):  
Magnetic Resonance ◽  
Vertebral Artery ◽  
Traumatic Event ◽  
Imaging Modality ◽  
Spin Echo ◽  
Vertebral Artery Dissection ◽  
Invasive Procedure ◽  
Artery Dissection ◽  
Content Type ◽  
Conventional Spin Echo

✓ Vertebral artery dissection may be spontaneous or related to some traumatic event. Diagnosis has usually been made by angiography, an invasive procedure with certain well-known risks. The authors describe the magnetic resonance (MR) appearance (both on conventional spin-echo and on gradient refocused “flow” sequences) in two patients with vertebral artery dissection confirmed by angiography. It is proposed that the less invasive MR imaging might be the imaging modality of choice for initial evaluation of suspected vertebral artery dissection.

A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery

1991 ◽  
Vol 75 (6) ◽  
pp. 874-882 ◽  
Author(s):  
Osamu Sasaki ◽  
Hiroshi Ogawa ◽  
Tetsuo Koike ◽  
Takayuki Koizumi ◽  
Ryuichi Tanaka
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Arterial Wall ◽  
Vertebral Artery Dissection ◽  
Intramural Hematoma ◽  
Artery Dissection ◽  
Content Type ◽  
Causative Factors ◽  
Dissecting Aneurysms ◽  
Vertebral Dissection

✓ Five autopsied cases of dissecting aneurysms of the intracranial vertebral artery are reported and the literature is reviewed to clarify the clinicopathological correlations. In an autopsy series of 110 patients with subarachnoid hemorrhage (SAH), the incidence of this entity was 4.5%, with all five cases progressing rapidly to death from massive SAH. Cases of intracranial vertebral dissection can be divided clearly into two groups based on the clinical and pathological features. In the first group, the dissection is confined to the vertebral artery and a massive SAH develops caused by the rupture of the arterial wall. The plane of dissection is mainly subadventitial. In the second group, brain-stem infarction develops resulting from luminal occlusion by intramural hematoma. The plane of dissection is mainly subintimal, with the dissection extending to the basilar artery. The condition in the second group affects patients at a younger age. If the lesion is localized within the vertebral artery and does not extend to the basilar artery, the disease seems not to be fatal. The clinical features of the vertebral dissection are largely determined by the plane and extension of dissection. Vertebral artery dissection is due to many causative factors including hypertension, congenital or degenerative changes in the arterial wall, and anatomical and pathological characteristics of the vertebral artery.

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

2000 ◽  
Vol 93 (1) ◽  
pp. 19-25 ◽  
Author(s):  
Kazuhiko Nakagawa ◽  
Hajime Touho ◽  
Toshitaka Morisako ◽  
Yasuhiko Osaka ◽  
Kazunori Tatsuzawa ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Clinical Aspects ◽  
Artery Dissection ◽  
Subsequent Formation ◽  
Content Type ◽  
Management Protocol ◽  
Stenotic Lesions ◽  
Fine Print

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.

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