Article
Subarachnoid haemorrhage based on posterior circulation dissections – a single-centre experience
Subarachnoidalblutung bei Dissektionen des hinteren Kreislaufs – eine monozentrische Studie
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Authors
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Christian Fung
- Universitätsklinik Freiburg, Neurochirurgie, Freiburg, Deutschland
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Werner Z’Graggen
- Universitätsklinik Bern, Neurochirurgie, Bern, Switzerland
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Andreas Raabe
- Universitätsklinik Bern, Neurochirurgie, Bern, Switzerland
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Jan Gralla
- Universitätsklinik Bern, Institut für Diagnostische und Interventionelle Neuroradiologie, Bern, Switzerland
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Jürgen Beck
- Universitätsklinik Freiburg, Neurochirurgie, Freiburg, Deutschland
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Felix Zibold
- Universitätsklinik Bern, Institut für Diagnostische und Interventionelle Neuroradiologie, Bern, Switzerland
| Published: | May 8, 2019 |
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Outline
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Objective: Arterial dissection is a rare cause of SAH and most often occurs in the posterior circulation. Diagnosis of the dissection is not always clear and treatment options include a variety of endovascular and surgical techniques. Treatment carries the high risk of re-rupture, ischemia and hemorrhage with moderate outcome necessitating an interdisciplinary approach. Here, we describe our single center experience in the treatment of patients with SAH due to posterior circulation dissection.
Methods: We performed a retrospective analysis of 30 patients with SAH due to posterior circulation arterial dissection. Diagnosis of arterial dissection and treatment parameter were evaluated as well as clinical course and long term follow up. Good outcome is defined as a modified Rankin score ≥2.
Results: Thirty patients (13 female) with a median age of 53 years were included. Dissection was located on V4 in 16 patients, PICA 11, basilary artery 1 and SCA 2, respectively. In 21 patients there were additional dissecting aneurysms. Three patients presented a re-rupture before treatment of the dissection and 2 during treatment. Primary treatment for dissection and dissecting aneurysms was endovascular in 26 and surgical in 2 patients. One patient showed a spontaneous occlusion of the vertebral artery and in one patient treatment was not possible. In 16 patients treatment of the dissecting vessel was occlusive and 18 patients had procedure-related infarcts after treatment. Twenty patients reached a good outcome one year after SAH.
Conclusion: SAH based on posterior circulation dissection requires a combined treatment approach. Despite the severity of the disease and expected complications due to the often occlusive approach of the therapy, the outcome of patients warrants aggressive treatment.
