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Outcomes and prognostic factors of intracranial unruptured vertebrobasilar artery dissection

Authors
 B.M. Kim  ;  S.H. Kim  ;  S.S. Ahn  ;  K.Y. Park  ;  S.I. Park  ;  D.J. Kim  ;  S.H. Suh  ;  Y.S. Shin  ;  D.I. Kim 
Citation
 Neurology, Vol.76(20) : 1735-1741, 2011 
Journal Title
 Neurology 
ISSN
 0028-3878 
Issue Date
2011
Abstract
OBJECTIVE: We aimed to evaluate the long-term clinical outcomes and prognostic factors of symptomatic intracranial unruptured vertebrobasilar artery dissection (siu-VBD). METHODS: A total of 191 patients (M:F = 127:64; median age, 46 years) with siu-VBD were treated between January 2001 and December 2008. Presentations, treatments, outcomes, and prognostic factors were retrospectively analyzed. RESULTS: Clinical manifestations were ischemic symptoms with headache (n = 97) or without headache (n = 13) and headache without ischemic symptoms (n = 81). Forty-six patients (24.1%) underwent endovascular treatment. The remaining 145 patients (75.9%) were medically treated with anticoagulants (n = 49), antiplatelets (n = 48), or analgesics alone (n = 48). Clinical follow-up data were available in 178 patients (102 ischemic and 76 nonischemic) at 15 to 102 months (mean, 46 months). None of the siu-VBD hemorrhaged. All 76 patients without ischemic presentation had favorable outcomes (modified Rankin Scale, 0-1). Of the 102 patients with ischemic presentation, outcomes were favorable in 92 and unfavorable in 10 patients. Four patients died; 3 died of causes unrelated to VBD, and one died as a result of basilar artery (BA) dissection. Old age (odds ratio [OR] 1.099; 95% confidence interval [CI] 1.103-1.204; p = 0.042) and BA involvement (OR 11.886; 95% CI 1.416-99.794; p = 0.023) were independent predictors of unfavorable outcomes in siu-VBD with ischemic presentation. CONCLUSIONS: Clinical outcomes for siu-VBD were favorable in all patients without ischemic symptoms and in most patients with ischemic presentation. None of the siu-VBD caused subarachnoid hemorrhage. Old age and BA involvement were independent predictors of unfavorable outcome in siu-VBD with ischemic presentation.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/93297
DOI
10.1212/WNL.0b013e31821a7d94
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
Yonsei Authors
김동익(Kim, Dong Ik) ; 김동준(Kim, Dong Joon) ; 김병문(Kim, Byung Moon) ; 박근영(Park, Keun Young) ; 박성일(Park, Sung Il) ; 서상현(Suh, Sang Hyun) ; 안성수(Ahn, Sung Soo)
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Full Text
http://www.neurology.org/content/76/20/1735.long
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