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Title: Treatment outcomes in cerebral artery dissection and literature review
Authors: Karanarak Urasyanandana
Dittapong Songsang
Taweesak Aurboonyawat
Ekawut Chankaew
Pattarawit Withayasuk
Anchalee Churojana
Faculty of Medicine, Siriraj Hospital, Mahidol University
Phramongkutklao College of Medicine
Keywords: Medicine
Issue Date: 1-Jun-2018
Citation: Interventional Neuroradiology. Vol.24, No.3 (2018), 254-262
Abstract: © 2018, © The Author(s) 2018. Methods: Patients with cerebral artery dissections were reviewed in a hospital setting from 2008 to 2015. Clinical presentations, lesion locations, treatment modalities, functional outcomes, and mortality were reviewed. Parent artery occlusion was the first choice for surgery or endovascular treatment of a hemorrhagic dissecting cerebral artery. Endovascular or surgical reconstructive treatment was indicated in patients whose parent artery could not be occluded. Favorable functional outcomes were determined using modified Rankin Scale (mRS) scores of 0–2. Results: In total, 61 patients with cerebral artery dissections were admitted to the hospital. Seven (11.5%) had traumatic dissections. All traumatic dissections were located in the internal carotid arteries. Overall favorable outcome rate was about 57% (4/7). Spontaneous cerebral artery dissections were found in 54 patients. No difference in favorable outcomes was observed between parent vessel occlusion and selective occlusion with parent vessel preservation (or vessel reconstruction) (70% and 63%, respectively, p = 1.000). Patients who presented with spontaneous dissection without intracranial hemorrhage had more favorable outcomes than those with intracranial hemorrhage (79% and 52%, respectively, p = 0.045). The mortality rate of patients with spontaneous dissection was 7.4%. Conclusions: Most of the traumatic dissections were located on the internal carotid arteries and spontaneous dissections were commonly located on vertebral arteries. Nonhemorrhagic spontaneous cerebral dissections had better functional outcomes after treatment. Endovascular and surgical management were effective treatments by parent vessel occlusion or reconstructions.
ISSN: 15910199
Appears in Collections:Scopus 2018

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