The diagnosis and treatment of intracranial arterial dissection and dissecting aneurysms

Abstract

Objective To investigate the clinical characteristics of intracranial arterial dissection (IAD) and intracranial dissecting aneurysms (IDA) and to evaluate the advantages and disadvantages of various diagnostic and therapeutic methods. Methods From December 2003 to December 2016, a total of 86 cases of intracranial artery dissection and dissecting aneurysms were treated at Neurosurgery Department, Wuhan General Hospital of PLA. Sixty-five patients were treated with endovascular therapy. Among them, 7 patients were treated with coil embolization, 38 with stent overlapping technique, 18 with stent-assisted coiling and 2 with coil-assisted silk embolization. Twenty-one patients did not undergo surgical treatment. The degree of embolization of each patient was inspected immediately after the endovascular therapy. The patients were followed up to assess mRS (modified Rankin scale) and recurrence through CTA or DSA. Results Sixty-five cases were treated successfully with endovascular treatment. The post-procedure DSA demonstrated that 53 cases were totally embolized and the other 12 cases were partially embolized. There were 3 patients developing neurologic deficit and 1 death due to re-bleeding. Among 21 cases undergoing conservative treatment, 5 cases died due to re-bleeding. Sixty-four cases were followed up for 6-12 months with an average of 8.7 months. There were 59 patients with favorable outcome (mRS: 0-1) and 5 patients with unfavorable outcome (mRS: > 2). The follow-up CTA or DSA suggested that 3 cases that were embolized partially with stent-assisted had recurrence with aneurysm enlargement. Reoperations were implemented in those 3 cases with parent artery occlusion in 2 cases and supplementary coiling in the other one. Conclusions The IAD and IDA are relatively rare kinds of cerebrovascular diseases with main manifestation of subarachnoid hemorrhage. The occurrence and progression of IAD and IDA are related to multiple factors and endovascular treatment usually leads to favorable outcome. Stent overlapping technique and stent-assisted coiling seem to be the primary endovascular therapies. Occlusion of lesioned vessel or parent artery could be considered as complementary method. Key words: Aneurysm, dissecting; Intracranial artery dissection; Diagnosis, differential; Endovascular treatment; Treatment outcome