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Clinical analysis of vertebrobasilar dissection

Cited 32 time in Web of Science Cited 36 time in Scopus
Authors
Kim, C. H.; Son, Y. J.; Paek, S. H.; Han, M. H.; Kim, J. E; Chung, Y. S.; Kwon, B. J.; Oh, C. W; Han, D. H
Issue Date
2006-03-03
Publisher
Springer Verlag
Citation
Acta Neurochir 148: 395-404
Keywords
Vertebrobasilar arteryAduldissectiontsubarachnoid hemorrhageinfarction
Abstract
BACKGROUND: The natural history of vertebrobasilar artery dissection (VAD) is not fully known. The purpose of this study was to review the clinical outcome of the patients with VAD, then to propose an appropriate management strategy for VAD. METHOD: From 1992 to 2004, 35 VAD patients admitted to our institutes were retrospectively reviewed. There were 28 men and 7 women, whose age ranged from 4 to 67 years with a mean age of 44 years. Angiography was assessed to document the shape, and location of the dissecting aneurysm with respect to the posterior inferior cerebellar artery (PICA). A modified Rankin score was assigned for functional outcome. The functional outcome scores were analyzed according to the patient's age, gender, hypertension history, the pattern of initial manifestation, angiographic shape of VAD, angiographic location of VAD, treatment modality. FINDINGS: There was no statistically significant difference between the functional outcome with age, gender, trauma history and past medical history of hypertension. Of 35 patients, 22 presented with SAH, 11 with ischemic symptoms and 2 were incidentally detected. The patients without SAH had a better functional outcome than those with SAH (p = 0.029). There was statistical significance between Hunt-Hess (H-H) grade and clinical outcome (p = 0.032). The shape and location of VAD was not significantly related to the functional outcome (p = 0.294, 0.840). But all the cases of rebleeding and mortality (except one case with initially poor H-H grade) developed exclusively in patients with aneurysms. There was no statistically significant correlation between the treatment modality and the outcome (p = 0.691). CONCLUSION: The VAD patients with SAH would be recommended to be managed by either surgical or endovascular treatment, but those without SAH, could be managed conservatively with antiplatelet therapy and/or anticoagulation.
ISSN
0001-6268 (print)
0942-0940 (online)
Language
English
URI
http://hdl.handle.net/10371/9887
DOI
https://doi.org/10.1007/s00701-006-0742-4
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College of Medicine/School of Medicine (의과대학/대학원)Radiology (영상의학전공)Journal Papers (저널논문_영상의학전공)
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