American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2017, 5(8), 202-204
DOI: 10.12691/ajmcr-5-8-2
Open AccessArticle

Unruptured Vertebral Artery Dissecting Aneurysms: Approach Strategy by Retrospective Analysis

Arash Dooghaie Moghadam1, Ali Keipourfard2 and Yasaman Arjmand1,

1Department of Radiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2Bone Joint and Related Tissue Research Center, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Pub. Date: August 17, 2017

Cite this paper:
Arash Dooghaie Moghadam, Ali Keipourfard and Yasaman Arjmand. Unruptured Vertebral Artery Dissecting Aneurysms: Approach Strategy by Retrospective Analysis. American Journal of Medical Case Reports. 2017; 5(8):202-204. doi: 10.12691/ajmcr-5-8-2

Abstract

Objectives: The natural course of un-ruptured vertebral artery dissecting aneurysms (VADAs) is not completely clear. We aim to retrospectively develop a strategy for treating un-ruptured VADAs based on long-term follow-up. Methods: We retrospectively studied 35 patients with un-ruptured VADAs. The initial symptom of 20 patients was headache, followed by ischemic symptoms and mass effect in 11 and 4 patients respectively. All of the patients underwent Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) at the time of admission and 2 weeks and 1, 4, 6, 12, and 24 months after initial presentation. Asymptomatic patients with enlarging dissection site defined on MRI and MRA, received further treatment and work up. Results: Two patients received emergency intervention due to symptom exacerbation and unstable status. The other 33 patients underwent conservative management. Lesion enlargement was observed in 2 cases during imaging follow up. In follow up period, additional interventions including dissection trap by surgery and coil embolization were conducted in 1 and 3 patients respectively. Other 31 patients remain symptom free and were managed conservatively. Dissection site remained unchanged in majority of patients (68.57%), improved in 28.57% and disappeared in 2.85% of the patients. Ten patients with recurrent ischemic attacks underwent anti-platelet therapy, without any bleeding complaint or permanent neurological deficits. Conclusion: The nature of an un-ruptured VADA is not highly aggressive. However, enlarged dissection site without new manifestations, occlusion is recommended. Also, anti-platelet therapy is suggested in patients with recurrent ischemic attacks.

Keywords:
vertebral artery dissecting aneurysm magnetic resonance imaging conservative treatment recurrent ischemic attacks anti-platelet therapy

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References:

[1]  Kristensen, B., Malm, J., Carlberg, B., Stegmayr, B., Backman, C., Fagerlund, M., Olsson, T., “Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern Sweden,” Stroke, 28(9). 1702-9. 1997.
 
[2]  Sato, T., Sasaki, T., Suzuki, K., Matsumoto, M., Kodama, N., Hiraiwa, K., “Histological study of the normal vertebral artery—Etiology of dissecting aneurysms,” Neurologia medico-chirurgica, 44(12). 629-635. 2004.
 
[3]  Nikouei, A., Seddighi, A., Seddighi, A.S., “The Results of Image Guided Surgery Using Neuronavigation in Resection of Cerebral Gliomas in Eloquent Cortical Areas,” Archives of Physical Medicine and Rehabilitation, 97(10). e69-70. 2016.
 
[4]  Haldeman, S., Kohlbeck, F.J., McGregor, M., “Stroke, cerebral artery dissection, and cervical spine manipulation therapy,” Journal of neurology, 249(8). 1098-1104. 2002.
 
[5]  Savitz, S.I., Caplan, L.R., Edlow, J.A., “Pitfalls in the diagnosis of cerebellar infarction,” Academic emergency medicine, 14. 63-68. 2007.
 
[6]  Pozzati, E., Padovani, R., Fabrizi, A., Sabattini, L., Gaist, G., “Benign arterial dissections of the posterior circulation,” Journal of Neurosurgery, 75(1). 69-72. 1991.
 
[7]  Yoshimoto, Y., Wakai, S., “Unruptured intracranial vertebral artery dissection. Clinical course and serial radiographic imagings,” Stroke, 28(2). 370-374. 1997.
 
[8]  Kim, Y.K., Schulman, S., “Cervical artery dissection: pathology, epidemiology and management,” Thrombosis research, 123(6). 810-21. 2009.
 
[9]  Seddighi, A., Nikouei, A., Seddighi, A.S., Zali, A.R., Tabatabaei, S.M., Sheykhi, A.R., Yourdkhani, F., Naeimian, S., “Peripheral Nerve Injury: A Review Article,” International Clinical Neuroscience Journal, 3(1). 1-6. 2016.
 
[10]  Mizutani, T., Kojima, H., Miki, Y., “Arterial dissections of penetrating cerebral arteries causing hypertension-induced cerebral hemorrhage,” Journal of Neurosurgery, 93(5). 859-862. 2009.
 
[11]  Nakagawa, K., Touho, H., Morisako, T., Osaka, Y., Tatsuzawa, K., Nakae, H., Owada, K., Matsuda, K., Karasawa, J., “Long-term follow-up study of unruptured vertebral artery dissection: clinical outcomes and serial angiographic findings,” Journal of Neurosurgery, 93(1). 19-25. 2000.
 
[12]  Nagahata, M., Manabe, H., Hasegawa, S., Takemura, A., “Morphological change of unruptured vertebral artery dissection on serial MR examinations. Evaluation of the arterial outer contour by basi-parallel anatomical scanning (BPAS)-MRI,” Interventional Neuroradiology, 12(suppl 1). 133-136. 2006.
 
[13]  Takada, H., Hyogo, T., Kataoka, T., Hayase, K., Nakamura, H., “Diagnosis of vertebral artery dissection by basi-parallel anatomical scanning (BPAS) MRI,” Interventional Neuroradiology, 12(suppl 1). 129-132. 2006.
 
[14]  Seddighi, A., Akbari, M.E., Seddighi, A.S., Pirayesh, E., Soleymani, M.M., Baqdashti, H.R., Nikouei, A., Zali, A., Tabatabaei, S.M., Naimian, S., Mellati, O., “Radioguided surgery using gamma detection probe technology for resection of cerebral glioma,” Hellenic journal of nuclear medicine, 18(suppl 3). 68-75. 2014.
 
[15]  Maillo, A., Diaz, P., Morales, F., “Dissecting aneurysm of the posterior cerebral artery: spontaneous resolution,” Neurosurgery, 29(2). 291-294. 1991.
 
[16]  Naito, I., Iwai, T., Sasaki, T., “Management of intracranial vertebral artery dissections initially presenting without subarachnoid hemorrhage,” Neurosurgery. 51(4). 930-937. 2002.
 
[17]  Tsutsumi, M., Kawano, T., Kawaguchi, T., Kaneko, Y., Ooigawa, H., “Dissecting aneurysm of the vertebral artery causing subarachnoid hemorrhage after non-hemorrhagic infarction,” Neurologia medico-chirurgica, 40(12). 628-631. 2000.
 
[18]  Yamaura, A., Isobe, K., Karasudani, H., Tanaka, M., Komiya, H., “Dissecting aneurysms of the posterior inferior cerebellar artery,” Neurosurgery, 28(6). 894-898. 1991.
 
[19]  Iihara, K., Sakai, N., Murao, K., Sakai, H., Higashi, T., Kogure, S., Takahashi, J.C., Nagata, I., “Dissecting aneurysms of the vertebral artery: a management strategy,” Journal of Neurosurgery, 97(2). 259-267. 2002.
 
[20]  Shafigh, M., Fatouraee, N., Seddighi, A., “Determining the biomechanical properties of human intracranial blood vessels through biaxial tensile test and fitting them to a hyperelastic model,” Engineering Solid Mechanics, 1(2):43-56. 2013.
 
[21]  Schievink, W.I., “Spontaneous dissection of the carotid and vertebral arteries,” New England Journal of Medicine, 344(12). 898-906. 2001.
 
[22]  Ro, A., Kageyama, N., Abe, N., Takatsu, A., Fukunaga, T., “Intracranial vertebral artery dissection resulting in fatal subarachnoid hemorrhage: clinical and histopathological investigations from a medicolegal perspective,” Journal of Neurosurgery, 110(5). 948-954. 2009.