抄録
Intracranial arterial dissection is considered to be not a rare disease recently, but the natural history of this disease is not well known yet. In this study, we analyzed the serial changes of angiographical or MRI/MRA finding and the long-term outcome to clarify the treatment strategy in patients with non-hemorrhagic intracranial arterial dissection.
Among 120 consecutive patients with arterial dissection of the vertebrobasilar system, 44 (37%) presented with ischemia and/or headache. Ages ranged from 27 to 77 years (mean: 49.3+/-11.0 years). Thirty-nine patients were managed conservatively and an antiplatelet agent was given in 10 because of history of myocardial or brain ischemia. Only 5 were treated surgically because the lesion had been enlarged or extended on the follow-up study. The vertebral artery was most commonly affected. On the initial angiographical or MRI/MRA finding, fusiform dilatation (43%) was the most frequent finding, followed by pearl and string sign (32%). In the serial changes of the findings, no change (43%) was most common, followed by improvement (37%).
Among 39 patients who presented with ischemia, 8 (21%) had subsequent symptoms (ischemia in 7, subarachnoid hemorrhage in 1). Recurrence tended to occur more frequently in the antiplatelet group. The follow-up period ranged from 1 to 17 years (mean: 5.8+/-4.1 years). The long-term outcomes were generally favorable. Thirty-three patients (85%) recovered well and 3 died among the 39 conservatively managed patients. Four of 5 patients achieved good recovery and returned to work in the surgically treated group. In addition, the outcomes in the antiplatelet group did not differ significantly from those without the above agents.
These results were quite similar to those in the nationwide study, and suggest that conservative treatment, mainly the control of high blood pressure, is the first choice in the non-hemorrhagic arterial dissection of the vertebrobasilar system and that antiplatelet or anticoagulant therapy might not be indicated in the patient with ischemia. Furthermore, the surgical indication for this disease remains controversial, and the study of a larger number of patients is indispensable to clarify this issue.
