Dissecting aneurysms of the vertebrobasilar system. A comprehensive review on natural history and treatment options

Santos-Franco, Jorge Arturo; Zenteno, Marco; Lee, Ángel

doi:10.1007/s10143-008-0124-x

Cited by 91 publications

(60 citation statements)

References 68 publications

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“…1 They are significantly less frequent than saccular lesions but usually more difficult to treat, with a devastating natural history and up to 80% mortality in 5 years if left untreated. Dissecting aneurysms pose a great challenge to both surgical and endovascular treatments due to their location and anatomic configuration.…”

mentioning

confidence: 99%

The Role of the Pipeline Embolization Device for the Treatment of Dissecting Intracranial Aneurysms

Faria¹,

Castro²,

Lundquist³

et al. 2011

AJNR Am J Neuroradiol

139

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SUMMARY:Intracranial dissecting aneurysms constitute rare lesions with complex management and elevated morbidity and mortality. Results of 23 patients harboring such lesions treated with the PED are reported. Standard dual antiplatelet therapy was instituted. Neurologic and angiographic assessments were obtained at 3, 6, and 12 months. Clinical presentation included SAH (52%), symptoms of mass effect (22%), ischemia (4%), and incidental finding (22%). The posterior circulation was affected in 91% of cases. Total occlusion was demonstrated in 69.5% of patients, with an increment to 87.5% considering only patients with at least 3 months of follow-up. Small aneurysms demonstrated higher rates of total occlusion (6/7) compared with large (5/7) and giant (5/9) ones. Good clinical outcome was achieved in 74% of patients. Reconstructive endovascular treatment of intracranial dissecting aneurysms with the PED provided good clinical and angiographic results with acceptable risks, representing an attractive therapeutic option for this complex disease, especially when parent vessel preservation is mandatory.ABBREVIATIONS: DSA ϭ digital subtraction angiography; GOS ϭ Glasgow Outcome Score; ICA ϭ internal carotid artery; PED ϭ Pipeline Embolization Device; PICA ϭ posterior inferior cerebellar artery; SAH ϭ subarachnoid hemorrhage D issecting aneurysms of the intracranial circulation are uncommon, accounting for 3% of all cerebral aneurysms.

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mentioning

confidence: 99%

The Role of the Pipeline Embolization Device for the Treatment of Dissecting Intracranial Aneurysms

Faria¹,

Castro²,

Lundquist³

et al. 2011

AJNR Am J Neuroradiol

139

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“…2,14 Extracranial dissection is more common than intracranial, but the V 2 segment (dissected in this case) is the least common of the extracranial segments to dissect because it remains relatively fixed within the transverse foramina along its course. 15 The first and third segments are highly mobile and, thus, are more frequently involved in dissection. 15 Most dissections of the VA are spontaneous, while others can be considered traumatic in etiology.…”

Section: Discussionmentioning

confidence: 99%

“…15 The first and third segments are highly mobile and, thus, are more frequently involved in dissection. 15 Most dissections of the VA are spontaneous, while others can be considered traumatic in etiology. 16 In the present case, the dissection was considered spontaneous.…”

Section: Discussionmentioning

confidence: 99%

“…4 Digital subtraction angiography has been the gold standard in imaging of arterial dissection. 15 Findings include luminal stenosis or occlusion, aneurysmal dilation, intimal flap, and double lumen. 2 MRI and MRA are replacing conventional catheter angiography as they are non-invasive, lack ionizing radiation, and offer multiplanar imaging of all major arteries (and veins) of the head and neck.…”

Section: Discussionmentioning

confidence: 99%

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Recognition of Spontaneous Vertebral Artery Dissection Preempting Spinal Manipulative Therapy: A Patient Presenting With Neck Pain and Headache for Chiropractic Care

Mattox

Smith²,

Kettner

2014

Journal of Chiropractic Medicine

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Objective: The purpose of this case report is to describe a patient who presented to a chiropractic physician for evaluation and treatment of neck pain and headache. Clinical features: A 45-year-old otherwise healthy female presented for evaluation and treatment of neck pain and headache. Within minutes, non-specific musculoskeletal symptoms progressed to neurological deficits, including limb ataxia and cognitive disturbances. Suspicion was raised for cerebrovascular ischemia and emergent referral was initiated. Intervention and outcome: Paramedics were immediately summoned and the patient was transported to a local hospital with a working diagnosis of acute cerebrovascular ischemia. Multiplanar computed tomographic and magnetic resonance imaging with contrast revealed vertebral artery dissection of the V 2 segment in the right vertebral artery. Anticoagulation therapy was administered and the patient was discharged without complications after 5 days in the hospital. Conclusion: This case highlights the potential for patients with vertebral artery dissection to present with nonspecific musculoskeletal complaints. Neurological symptoms may not manifest initially, but their sudden onset indicates the possibility of an ischemic cerebrovascular event. We suggest that early recognition and emergent referral for this patient avoided potential exacerbation of an evolving pre-existing condition and resulted in timely anticoagulation treatment.

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“…As these symptoms are nonspecific and may be related to a number of underlying conditions, it can be difficult to properly diagnose a VAD. 7 Currently, medical treatment of www.journalchiromed.com this condition includes administration of anticoagulant drugs. 8 Vertebral artery dissection is the result of a flap-like tear in the tunica intima of the vertebral artery.…”

Section: Introductionmentioning

confidence: 99%

Vertebral artery dissection in a patient practicing self-manipulation of the neck

Mosby

Duray

2011

Journal of Chiropractic Medicine

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Objective: The purpose of this case report is to describe a patient who regularly practiced self-manipulation of her neck who presented with shoulder and neck pain and was undergoing a vertebral artery dissection. Clinical Features: A 42-year-old female patient sought care for left shoulder pain with a secondary complaint of left lower neck pain. Twelve days prior, she had had "the worst headache of her life," which began in her left lower cervical spine and extended to her left temporal region. The pain was sudden and severe, was described as sharp and burning, and lasted 3 hours. She reported nausea, vomiting, and blurred vision. Intervention and Outcome: Initial history and examination suggested that the patient's head and neck pain was not musculoskeletal in origin, but vascular. She repeatedly requested that an adjustment be performed, but instead was referred to the local emergency department for further evaluation. Magnetic resonance angiogram revealed a dissection of the left vertebral artery from C6 to the C2-C3 interspace and a 3-mm dissecting pseudoaneurysm at the C3 level. She underwent stent-assisted percutaneous transluminal angioplasty combined with antiplatelet therapy (clopidogrel) and experienced a good outcome. Conclusion: This case suggests that careful history taking and awareness of the symptoms of VAD are necessary in cases of sudden head and neck pain. More research is needed on the relationship between vertebral artery dissection and self-manipulation of the neck.

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Dissecting aneurysms of the vertebrobasilar system. A comprehensive review on natural history and treatment options

Cited by 91 publications

References 68 publications

The Role of the Pipeline Embolization Device for the Treatment of Dissecting Intracranial Aneurysms

The Role of the Pipeline Embolization Device for the Treatment of Dissecting Intracranial Aneurysms

Recognition of Spontaneous Vertebral Artery Dissection Preempting Spinal Manipulative Therapy: A Patient Presenting With Neck Pain and Headache for Chiropractic Care

Vertebral artery dissection in a patient practicing self-manipulation of the neck

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