title: Strategy for treating unruptured vertebral artery dissecting aneurysms.
abstract: BACKGROUND
  The natural course of unruptured vertebral artery dissecting aneurysms (VADAs) remains unclear.
  
  
  OBJECTIVE
  The purpose of this retrospective study was to develop a strategy for treating unruptured VADAs based on long-term follow-up.
  
  
  METHODS
  Our study population consisted of 100 patients with unruptured VADAs; in 66, the initial symptom was headache only, 30 presented with ischemic symptoms and 4 with mass effect. All underwent magnetic resonance imaging and magnetic resonance angiography at the time of admission and 2 weeks and 1, 3, 6, 12, and 24 months after the onset. If the dissection site was demonstrated to be enlarged on magnetic resonance imaging and magnetic resonance angiography without the manifestation of new symptoms, the patients received additional treatment to prevent bleeding.
  
  
  RESULTS
  Of the 100 patients, 4 underwent early intervention because of symptom exacerbation. The other 96 were initially treated conservatively; during follow-up, 5 manifested lesion enlargement on magnetic resonance angiography. Nine patients received additional treatment; 1 underwent direct surgery with trapping of the dissection site, and 8 underwent coil embolization. The other 91 patients continued to be treated conservatively; the dissection site remained unchanged in 70, improved or healed in 18, and disappeared in 3 patients. We treated 38 patients with recurrent ischemic attacks with antiplatelet therapy. No patients experienced bleeding or permanent neurological deficits during follow-up.
  
  
  CONCLUSIONS
  The nature of an unruptured VADA is not highly aggressive. However, if the dissection site enlarges without the manifestation of new symptoms, it should be occluded. In patients with recurrent ischemic attacks antiplatelet therapy should be considered.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. ykai@fc.kuh.kumamoto-u.ac.jp
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kai
authors.forename: Toru
authors.initials: T
authors.lastname: Nishi
authors.forename: Masaki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Motohiro
authors.initials: M
authors.lastname: Morioka
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Hirano
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Yano
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ohmori
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kawano
authors.forename: Jun-ichiro
authors.initials: J
authors.lastname: Hamada
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Kuratsu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods*; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*