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Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection

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Title: Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection
Authors: Kashiwazaki, Daina Browse this author
Ushikoshi, Satoshi Browse this author
Asano, Takeshi Browse this author
Kuroda, Satoshi Browse this author →KAKEN DB
Houkin, Kiyohiro Browse this author →KAKEN DB
Keywords: Endovascular treatment
Internal trapping
Long-term follow-up
Vertebral artery dissection
Issue Date: Feb-2013
Publisher: Springer-Verlag
Journal Title: Neuroradiology
Volume: 55
Issue: 2
Start Page: 201
End Page: 206
Publisher DOI: 10.1007/s00234-012-1114-9
PMID: 23149552
Abstract: Purpose: Previous reports have suggested that endovascular parent artery occlusion is an effective and safe procedure for the treatment of vertebral artery dissection (VAD). However, the results of long-term outcomes are still unclear. This study reviewed the clinical and imaging outcomes of patients with VAD treated by endovascular internal trapping. Methods: A total of 73 patients were treated for VAD by endovascular internal trapping between March 1998 and March 2011. Patients were regularly followed up by magnetic resonance imaging, magnetic resonance angiography, and clinical examinations. Clinical outcomes were evaluated using the modified Rankin Scale. Results: Forty-five patients had ruptured VADs, and 28 had unruptured VADs. Clinical follow-up of at least 6 months data were obtained for 61 patients (83.6 %). The follow-up period ranged from 6 to 145 months (mean ± SD, 55.6 ± 8.9 months). Two patients with ruptured VADs had recurrence (2.74 %). Cranial nerve paresis (CNP) was observed in 6 patients (8.21 %), spinal cord infarction in 2 patients (2.74 %) and a perforating artery ischemia was diagnosed in 7 patients (9.59 %); all patients with CNP and 5 of the patients with partial Wallenberg syndrome experienced only temporary symptoms; 2 of the patients with partial Wallenberg syndrome had permanent neurological deficits. Despite their symptoms, most patients were in good general condition, as shown by their clinical scores. Conclusions: The results of this study have proven that endovascular internal trapping is a stable and durable treatment for closure of VADs. Recanalization is rather rare and occurred only in ruptured cases., both within 3 months after initial treatment without rupture. CNPs were observed in 8.21 %, perforating ischemia in 9.59 %, and spinal cord infarction in 2.74 %. The former two are temporary, while the last can be a factor that affect mRS. Patients rated their quality of life as good, as corroborated by their posttreatment clinical score. Endovascular internal trapping for VAD is a therapy with a satisfactory long-term outcome.
Rights: The original publication is available at www.springerlink.com
Type: article (author version)
URI: http://hdl.handle.net/2115/54552
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 宝金 清博

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