doi: 10.3174/ajnr.A1243
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American Journal of Neuroradiology 29:1937-1941, November-December 2008
© 2008 American Society of Neuroradiology
INTERVENTIONAL
Management and Clinical Outcome of Acute Basilar Artery Dissection
a Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
b Department of Neurosurgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
c Department of Neurology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
d Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
e Department of Radiology, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
f Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea
g Department of Radiology, Kyung Hee University Medical Center, Seoul, Korea
h Department of Neurosurgery, Kyung Hee University Medical Center, Seoul, Korea
i Department of Neurosurgery, Konkuk University Hospital, Seoul, Korea
j Department of Radiology, Konkuk University Hospital, Seoul, Korea
Please address correspondence to Yong Sam Shin, MD, Department of Neurosurgery, Ajou University College of Medicine, Suwon, Republic of Korea, 442-721; e-mail: nsshin{at}ajou.ac.kr
BACKGROUND AND PURPOSE: There have been inconsistencies on the prognosis and controversies as to the proper management of acute basilar artery dissection. The aim of this study was to evaluate acute basilar artery dissection and its outcome after management.
MATERIALS AND METHODS: A total of 21 patients (mean age, 53 years; range, 24–78 years) with acute basilar artery dissection were identified between January 2001 and October 2007. Clinical presentation, management, and outcomes were retrospectively evaluated.
RESULTS: The patients presented with subarachnoid hemorrhage (n = 10), brain stem ischemia (n = 10), or stem compression sign (n = 1). Ruptured basilar artery dissections were treated by stent placement with coiling (n = 4), single stent placement (n = 3), or conservatively (n = 3). Of the patients treated with endovascular technique, 6 had favorable outcome (modified Rankin scale [mRS], 0–2) and the remaining patient, who was treated by single stent placement, died from rebleeding. All 3 conservatively managed patients experienced rebleeding, of whom 2 died and the other was moderately disabled. Unruptured basilar artery dissections were treated conservatively (n = 7) or by stent placement (n = 4). Of the patients with unruptured basilar artery dissection, 9 had favorable outcome and the remaining 2 patients, both of whom were conservatively managed, had poor outcome because of infarct progression. The group with the ruptured basilar artery dissection revealed a higher mortality rate than the group with the unruptured dissection (30% vs 0%). The group treated with endovascular means revealed more favorable outcome than the group that was treated with conservative measures (90.9% vs 50%).
CONCLUSION: The ruptured basilar artery dissections were at high risk for rebleeding, resulting in a grave outcome. Stent placement with or without coiling may be considered to prevent rebleeding in ruptured basilar dissections and judiciously considered in unruptured dissections with signs of progressive brain stem ischemia.
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