非外傷性頭蓋内解離性動脈病変の全国調査 (第2報)

抄録

This is Part 2 of our report on a nationwide study of intracranial arterial dissection, carried out from July 1, 1995, through June 30, 1996. In this report, we discuss the treatment and results. Three hundred and fifty-seven patients with intracranial arterial dissection were classified into two groups: a hemorrhagic group of 206 patients (58%) presenting with subarachnoid hemorrhage, and a nonhemorrhagic group of 151 patients (42%) manifesting brain ischemia, headache or, no symptom. Among 322 patients with a single lesion, 299 (93%) lesions were located in the vertebrobasilar system, and only 23 (7%) in the carotid system. Medical treatment, such as anticoagulant therapy, given to the conservtive group presenting brain ischemia was also investigated.
Results: 1) Treatment: In the whole series, 61% of the patients in the hemorrhagic group were surgically treated, while 82% in the nonhemorrhagic group was conservatively managed. This difference was statistically significant (p<0.0001). Sixty-one percent and 55% of the patients were conservatively treated in the carotid system and the vertebrobasilar system, respectively. 2) Surgical procedure: In both the hemorrhagic and nonhemorrhagic groups, and in the vertebrobasilar system, proximal occlusion of the involved artery was the leading procedure, and intravascular surgery was the second. On the other hand, wrapping or coating was the main procedure in the carotid system. 3) Outcome: The outcome was better in the surgical group than in the conservative group of the hemorrhagic group, despite the fact that the severity on admission did not differ between the two groups. The outcome did not significantly differ between the surgical and conservative groups in the nonhemorrhagic group, and in both the carotid and the vertebrobasilar systems. Cerebral infarction was the most frequent postoperative intracranial complication in both the hemorrhagic and nonhemorrhagic groups. Anticoagulant and/or antiplatelet drugs were administered in 42% of the patients of the conservative group presenting with brain ischemia. However, the outcome did not significantly differ in the drug-treated group and the group treated without drugs.
The present study indicates that conservative treatment has recently been the more frequently chosen option, as compared with the data accumulated from the literature. The outcome might be favorable in the surgical group of the hemorrhagic group.