Efficacy, complications and clinical outcome of endovascular treatment for intracranial intradural arterial dissections.
OBJECTIVE
Intracranial intradural dissections are challenging to treat, and published data regarding treatment outcomes remains relatively limited. We retrospectively evaluated our experience with endovascular techniques in the treatment of intracranial intradural dissections, and describe the efficacy and clinical outcomes with treatment.


METHODS
Between January 2003 and December 2011, 23 patients with 23 intracranial intradural arterial dissections underwent endovascular treatment at our institution. Eighteen were treated with coil embolization (14 with parent vessel sacrifice, 4 with aneurysm coiling), 4 with flow diverting stents (Pipeline Embolization Device) and 1 with primary angioplasty and stenting. Treatment indications were subarachnoid hemorrhage (n=16), cerebral ischemia (n=2), headache (n=3), or elective (n=2).


RESULTS
The peri-procedural complication rate was 17.4%, 3 of the 4 cases sustained no serious clinical sequelae. Four deaths unrelated to the procedure occurred in patients with subarachnoid hemorrhage. Angiographic follow-up demonstrated complete occlusion in 8 of 14 surviving cases treated by coil embolization, incomplete occlusion in 2 cases. Four cases were lost to follow-up, but all of these had complete occlusion post-procedure. Successful angiographic outcomes were seen at follow-up in patients treated with flow diverting stents and primary intracranial stenting. Clinical follow-up showed a mRS of 0-1 in 15 (78.9%) of 19 patients, mRS of 2 in 1 patient, mRS of 3 in 1 patient and mRS of 5 in 1 patient. There was no neurological deterioration, re-bleeding or deaths during the follow-up period.


CONCLUSIONS
Intracranial arterial dissections, particularly those presenting with subarachnoid hemorrhage, are lesions associated with high mortality. They can be effectively managed endovascularly. In our experience, endovascular treatment can be associated with moderate peri-procedural risks.
Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Tiffany Y
TY
So
Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Peter J
PJ
Mitchell
Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Richard J
RJ
Dowling
Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia. Electronic address: Bernard.Yan@mh.org.au.
Bernard
B
Yan
D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000601:surgery; D001807:Blood Vessel Prosthesis; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013345:Subarachnoid Hemorrhage; D016896:Treatment Outcome; D055815:Young Adult
Angiography; Endovascular treatment; Intracranial arterial dissection; Subarachnoid hemorrhage