title: Dissecting aneurysms of the vertebral artery--angiographic patterns at the dissecting site on balloon test occlusion.
abstract: BACKGROUND
  At present, the risk of future hemorrhage or ischemic insult from vertebral artery (VA) dissection cannot be estimated from available imaging data. We investigated the relationship between symptoms and the angiographic patterns of the dissecting site on balloon test occlusion (BTO) to develop guidelines for clinical decision-making.
  
  
  METHODS
  We retrospectively reviewed 18 patients with unilateral VA dissection who presented with subarachnoid hemorrhage (SAH) or cerebral infarction. We analyzed the angiographic findings at the dissecting site on contralateral VA angiograms during BTO of the affected VA, classified the angiographic patterns into two types, and compared the symptoms they presented.
  
  
  RESULTS
  Patients with dissection opacified from the distal to the proximal side are more likely to present with cerebral infarction than SAH. Conversely, patients with dissection opacified from the proximal to the distal side had a significantly higher incidence of SAH.
  
  
  CONCLUSIONS
  Angiographic findings at the dissecting site on contralateral VA angiograms during BTO of the affected VA are helpful for considering the treatment and prognosis of patients with VA dissecting aneurysms.
authors.affiliation: Department of Cerebrovascular and Acute Coronary Syndrome, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Kumamoto, 860-8556, Japan. ykai@fc.kuh.kumamoto-u.ac.jp
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kai
authors.forename: Jun-ichiro
authors.initials: J
authors.lastname: Hamada
authors.forename: Motohiro
authors.initials: M
authors.lastname: Morioka
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ohmori
authors.forename: Masaki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Hirano
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kawano
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Yano
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Kuratsu
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000000981:diagnostic imaging* / Q000628:therapy; D021721:Balloon Occlusion; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000209:etiology; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D014711:Vertebral Artery