title: Symptomatic recurrence of intracranial arterial dissections: follow-up study of 143 consecutive cases and pathological investigation.
abstract: OBJECTIVE
  The frequency and pattern of symptomatic recurrence of spontaneous intracranial arterial dissection (IAD) are unknown.
  
  
  METHODS
  A follow-up study of 143 patients (85 men, 58 women; mean age, 50.7 [7-83] years) with spontaneous IADs at The University of Tokyo and affiliated hospitals from 1980 to 2000 was conducted. Tissue samples of IAD vessels obtained from 13 patients at various intervals from onset were also examined histologically.
  
  
  RESULTS
  With a mean follow-up of 8.2 years, symptomatic recurrence occurred in 47 patients (33%). Of 37 cases initially presenting with hemorrhage, 35 developed hemorrhagic recurrence with a mean interval of 4.8 days, and 2 developed nonhemorrhagic recurrences after 21 and 85 months, respectively. Of 10 patients initially presenting with nonhemorrhagic symptoms, 1 developed hemorrhagic recurrence 4 days later, and 9 developed nonhemorrhagic recurrences with a mean interval of 8.6 months. Histopathologically, the affected vessels in the acute stage of hemorrhage (days 0-6) demonstrated insufficient granulation formation within the pseudolumen, followed by marked intimal thickening around the pseudolumen and recanalizing vessel formation in the late stage (>day 30). In the late stage of brain ischemia, subintimal and subadventitial hemorrhage accompanied with intimal thickening was observed.
  
  
  CONCLUSIONS
  These data indicate that IAD is a disease carrying a relatively high risk of symptomatic recurrence, apparently occurring in 3 phases and patterns: early hemorrhagic recurrence, late nonhemorrhagic recurrence, and chronic fusiform aneurysm transformation. Knowledge of this triphasic recurrence and corresponding histopathological characteristics help determine the treatment and follow-up strategy for IAD patients.
authors.affiliation: Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Ono
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nakatomi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Inoue
authors.forename: Akira
authors.initials: A
authors.lastname: Teraoka
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Yoshimoto
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ide
authors.forename: Chifumi
authors.initials: C
authors.lastname: Kitanaka
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ueki
authors.forename: Hideaki
authors.initials: H
authors.lastname: Imai
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Saito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011859:Radiography; D055502:Secondary Prevention; D016896:Treatment Outcome; D055815:Young Adult