title: Outcomes and prognostic factors of intracranial unruptured vertebrobasilar artery dissection.
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.
authors.affiliation: Department of Radiology, Yonsei University College of Medicine Severance Hospital, 250 Seongsanno, 120-752, Seoul, Republic of Korea. bmoon21@hanmail.net
authors.forename: B M
authors.initials: BM
authors.lastname: Kim
authors.forename: S H
authors.initials: SH
authors.lastname: Kim
authors.forename: D I
authors.initials: DI
authors.lastname: Kim
authors.forename: Y S
authors.initials: YS
authors.lastname: Shin
authors.forename: S H
authors.initials: SH
authors.lastname: Suh
authors.forename: D J
authors.initials: DJ
authors.lastname: Kim
authors.forename: S I
authors.initials: SI
authors.lastname: Park
authors.forename: K Y
authors.initials: KY
authors.lastname: Park
authors.forename: S S
authors.initials: SS
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D002533:Cerebral Angiography; D038524:Diffusion Magnetic Resonance Imaging; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*
chemical_list: D000700:Analgesics; D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors