Treatment of hemorrhagic intracranial dissections.
OBJECTIVE
To analyze the treatment options in hemorrhagic intracranial dissections.


METHODS
This study involved a retrospective review of 27 patients with 29 dissections treated during a 16-year period, mainly by endovascular treatment (EVT).


RESULTS
EVT was performed in the acute stage in 12 of the 29 dissections, and occlusion was performed using coils at the dissection site in six dissections and with proximal balloon occlusion in six dissections. Wrapping was performed in one case. In the remaining 16 dissections, which were not treated, mainly for anatomic reasons, three patients died, one from rebleeding. Angiographic follow-up performed in the 13 surviving patients demonstrated an initially misdiagnosed lesion in one and worsening lesions in five that led to delayed EVT in five and surgical clipping in one. One of these dissections, which was located on a dominant vertebral artery, was treated after subsequent rupture using a stent and coils to preserve the patency of the parent vessel. Four ischemic complications related to EVT resulted in a moderate disability in two patients. No rebleeding occurred after EVT, but one patient died because of a poor initial clinical status; the other patients improved. In the 10 patients treated conservatively, four died, three from a poor initial clinical status and one from rebleeding, and six patients had a good clinical outcome. Of the 27 patients, three had rebleeding and one died as a result of that rebleeding. Seventeen patients (63%) had a good recovery, six (22%) had a moderate disability, and four (15%) died.


CONCLUSIONS
EVT provides effective protection against rebleeding. When possible, occlusion with coils at the dissection site is the current method of choice. Another option is parent artery occlusion with balloons, and the use of a stent may preserve vessel permeability in specific cases.
Anxionnat
René
R
Department of Neuroradiology, Nancy University Hospital, Nancy, France. r.anxionnat@chu-nancy.fr
de Melo Neto
João Ferreira
JF
Bracard
Serge
S
Lacour
Jean Christophe
JC
Pinelli
Catherine
C
Civit
Thierry
T
Picard
Luc
L
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D021721:Balloon Occlusion; D019917:Blood Vessel Prosthesis Implantation; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors