Abstract
The first nationwide survey for nontraumatic intracranial vertebrobasilar dissection (VAD) was conducted in Japan 20 years previously. The optimal treatment for ischemic VAD is still a controversial topic. We conducted a nationwide study over a 1-year period (2011) to examine the present status of management, outcomes, and factors influencing the outcome.
The response rate for this survey was 15.6% (172 responses/1104 total facilities). Of the 632 patients with VAD that were enrolled to this study, 209 patients had ischemic VAD. The median age at onset was 50 (21-85) years and 78.5% of the patients were men. In this cohort, 56.7% of the patients experienced headache at the onset. Wallenberg syndrome, motor paresis, sensory disturbance, and cranial nerve symptoms were also observed in 36.9%, 22.4%, 46.7%, and 25.8% of the patients, respectively. Symptomatic deterioration and recurrence were observed in 44 patients (21.1%).
With regard to patient management, 78.5% of the patients were treated with antithrombotic therapy. These treated patients had relatively severe neurological symptoms. No subarachnoid hemorrhage was observed in the ischemic VAD patients during the follow-up period. At the final follow-up, 72.4% of the patients achieved a favorable outcome (modified Rankin scale 0 to 1). Basilar artery dissection was related to clinical deterioration during the treatment, and diabetes mellitus was associated with a poor final outcome.
The clinical feature, radiological findings, and outcomes were found to be similar between the present and previous reports. In the current management of ischemic VAD patients in Japan, there is considerable variability in the use of antithrombotics. Patients with severe symptoms and/or supratentorial infarction frequently received antithrombotic therapy. To evaluate the efficacy of antithrombotic in the treatment of ischemic VAD, a prospective study is necessary. Moreover, the treatment selection bias can hardly be eliminated in a non-randomized trial.
