椎骨脳底動脈系の非出血性解離性動脈病変の治療方針(<特集>非出血性解離性脳動脈瘤の治療方針)  [in Japanese] Treatment Strategy of Non-hemorrhagic Arterial Dissection in Vertebrobasilar System (<Topics> Treatment Strategy of Non-hemorrhagic Intracranial Artery Dissection)  [in Japanese]

Intracranial arterial dissection is considered to be not a rare disease recently, but the natural history of this disease is not well known yet. In this study, we analyzed the serial changes of angiographical or MRI/MRA finding and the long-term outcome to clarify the treatment strategy in patients with non-hemorrhagic intracranial arterial dissection. Among 120 consecutive patients with arterial dissection of the vertebrobasilar system, 44 (37%) presented with ischemia and/or headache. Ages ranged from 27 to 77 years (mean: 49.3 +/- 11.0 years). Thirty-nine patients were managed conservatively and an antiplatelet agent was given in 10 because of history of myocardial or brain ischemia. Only 5 were treated surgically because the lesion had been enlarged or extended on the follow-up study. The vertebral artery was most commonly affected. On the initial angiographical or MRI/MRA finding, fusiform dilatation (43%) was the most frequent finding, followed by pearl and string sign (32%). In the serial changes of the findings, no change (43%) was most common, followed by improvement (37%).