A Pathological Study of Intracranial Posterior Circulation Dissecting Aneurysms with Subarachnoid Hemorrhage

Endo, Shunro; Nishijima, Michiharu; Nomura, Hiroaki; Takaku, Akira; Okada, Eikichi

doi:10.1227/00006123-199310000-00026

Cited by 80 publications

(40 citation statements)

References 21 publications

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“…Defects of the elastic lamina may play a role in siVAD because it is considered to be the most important layer for determining vessel strength, though whether these defects are congenital or acquired is not known [26,27]. In an autopsy study of fatal SAH caused by siVAD, pathological evidence of a previous healed dissection with an associated internal elastic lamina disruption was found in 43% of the cases [28].…”

Section: Discussionmentioning

confidence: 99%

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%

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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“…The basilar artery, like other intradural vessels, lacks an external elastic lamina and an adequately sized adventitia (both of which make extracranial vessels highly durable against rupture even in case of giant pseudoaneurysms) [6,20]. Typically, pathological studies in patients with IBAD and subarachnoid hemorrhage showed a plane dissection between the media and adventitia with disruption of the tunica media or occasionally of the entire thickness of the arterial wall [21,22,23]. Blood leakage may be limited to the basilar artery region, usually in a pretruncal distribution.…”

Section: Discussionmentioning

confidence: 99%

Basilar Artery Dissection: Series of 12 Consecutive Cases and Review of the Literature

et al. 2010

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Background: Current knowledge on primary or isolated basilar artery dissection (IBAD) is limited to case vignettes and small patient series. Objective: To delineate the frequency and clinical presentations of IBAD along with short-term outcome, specific prognosis and targeted management. Methods: Data were derived from a series of 12 consecutive patients and a review of 88 cases reported in the literature. In all the cases, the dissection was confined to the basilar artery. Results: Disease incidence was estimated at 0.25 per 100,000 person-years. IBAD accounted for roughly 1.0% of all subarachnoid hemorrhage events and for no less than 10.5 and 4.5% of posterior circulation and brain-supplying artery dissections, respectively. The main clinical presentations were subarachnoid hemorrhage (46%) and posterior circulation brain ischemia (42%). Subarachnoid hemorrhage typically manifested at a higher age than brain ischemia (mean age, 48.9 vs. 41.4 years) and was more prevalent among women. Rebleedings related to pseudoaneurysm formation in patients with subarachnoid hemorrhage and recurrent ischemia in stroke patients were common in the acute phase (26.1 and 33.3%, respectively) but were rare in the long term. The outcome was generally favorable in stroke patients but variable in subarachnoid hemorrhage (case fatality rate, 21.7%). The mainstay of therapy for subarachnoid hemorrhage related to IBAD was endovascular occlusion of the aneurysm pouch whereas stroke patients were usually put on anticoagulants. Conclusions: IBAD is probably an underrecognized disease with heterogeneous clinical presentation and prognosis. It should be considered as a differential diagnosis in peritruncal subarachnoid hemorrhage, classic subarachnoid hemorrhage and posterior circulation stroke, especially in young individuals. Case management is challenging and has to be tailored to each patient.

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“…Segmental mediolytic arteriopathy is reportedly an idiopathic disease of visceral and vertebral arteries that can cause fatal abdominal or subarachnoid hemorrhage [5][6][7][8][9][10][11][12][13]. Histologic features of segmental mediolytic arteriopathy are broadly separated into those representing vascular wall 'injury' and those representing 'repair' [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Traumatic subarachnoid hemorrhage and the COL3A1 gene: emergence of a potential causal link

Pickup

Pollanen

2010

Forensic Sci Med Pathol

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We describe two previously unreported associations in four cases. The first two cases demonstrate an association between segmental mediolytic arteriopathy and vascular Ehlers-Danlos syndrome. The second two cases illustrate an association between vascular Ehlers-Danlos syndrome and traumatic subarachnoid hemorrhage. In case 1, there was acute subarachnoid hemorrhage and mesenteric artery dissection. In case 2, there was an acute mesenteric artery dissection with intestinal infarction. In both cases 1 and 2, segmental mediolytic arteriopathy was found in the vertebral arteries. Cases 3 and 4 were sudden deaths from traumatic subarachnoid hemorrhage with intracranial vertebral artery rupture. Genetic testing in all four cases revealed point mutations in the type 3 procollagen gene (COL3A1), as observed in vascular Ehlers-Danlos syndrome. Based on the first two cases, we propose that segmental mediolytic arteriopathy may be a marker for this disease. We further suggest that vascular Ehlers-Danlos syndrome may be related to the pathogenesis of traumatic vertebral artery injury, in some cases. We recommend that cases of segmental mediolytic arteriopathy and traumatic subarachnoid hemorrhage undergo genetic testing for COL3A1 mutations.

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A Pathological Study of Intracranial Posterior Circulation Dissecting Aneurysms with Subarachnoid Hemorrhage

Cited by 80 publications

References 21 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

Basilar Artery Dissection: Series of 12 Consecutive Cases and Review of the Literature

Traumatic subarachnoid hemorrhage and the COL3A1 gene: emergence of a potential causal link

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